“Jongdae!”

Jongdae turns. His heart is already sinking even before he rests eyes on the person calling him, because he knows that sharp voice very well. His eyes flick up and down the hospital corridor before settling on the slim middle-aged woman in a white coat approaching him. He is looking for - hoping for - the presence of other people, but the reflex is so deeply ingrained in him that he isn’t consciously aware of it. But there is nobody else in the corridor that separates the obstetrics and gynaecology department from the labour and delivery unit, and Jongdae grips his clipboard a little tighter as he sends Dr. Heo a pleasant smile. In heels she stands at eye-level with him, and is as well-groomed as always, bobbed hair dyed a gleaming russet, fine-boned face perfectly made-up, any wrinkles that might have arrived with the onset of her fourth decade ruthlessly banished with Botox.

“Yes, Chief Heo?” he answers politely, as he always does, despite the abrupt, almost rude tone she always uses with him. He’s been working under Dr. Heo Youngae, the obstetrics and gynaecology department chief and a renowned specialist in obstetric infectious diseases, for his entire career, and he’s pretty sure she’s never really seen him as anything more than the clueless intern she first laid eyes on seven years ago.

“I want you on call tonight,” she tells him. “Your shift will end at 10 am tomorrow.”

Jongdae’s heart takes another swoop towards his shoes. He was on call last night too, and it was a busy one. He'd snatched less than three hours’ sleep total between multiple calls to the ED and the recurrent, gruesome nightmare that has been plaguing him for the past few weeks. If he doesn’t get off until 10 am tomorrow, he’ll have been working 40 hours straight. Nothing he hasn’t done before, of course, but the number of extended or back-to-back shifts the chief has been loading him with is just getting higher and higher. Ahreum is starting to complain that he might as well be working in a different country, for all she gets to see of him.

He rubs his fingers anxiously down the edge of his plastic clipboard. “I was on call last night too…” he starts, then trails off as Dr. Heo’s eyebrows snap together and her face darkens. He knows that expression. Knows it far too well.

“So?” Her tone is aggressive.

“Well, I just...it’s just that means I’ll have been here for forty hours straight, and I’ve already done a thirty-six hour shift this week, with only a day off between,” he explains. He tries to sound reasonable, but she's already making him nervous, stealing his coherency, making him feel like a stammering intern again. “And, you know, I have a family. I promised my wife I’d be home tonight. I’d really rather not take this one.”

He should have known better than to argue. She takes a step forward, getting right in his face. Jongdae takes an automatic step back and finds himself backed up against the wall. He can smell her perfume. His hands start to sweat, but he refuses to let his nervousness show. He’s been dealing with Heo Youngae since he was 23 years old. He knows all to well that showing discomfort only makes her worse.

“Oh, I see.” Dr. Heo’s tone drips with sarcasm. “You’re going to slide out of this and let your juniors pick up your slack, is that it?” She jabs a sharp finger against his forehead, making his head rock back. Jongdae feels a shiver of dread crawl up and down his bones. He grips his clipboard tighter than ever. There's nobody around, but it's still a public corridor. She won't...

“You’ve gotten rather full of yourself since becoming an attending surgeon, Jongdae," Dr. Heo continues acidly. "I never picked you for the type to slack off, but I guess I was wrong.”

Jongdae nearly gasps aloud at the sheer unfairness of this, but he manages to contain the reaction. Even so, it stings. He’s been sacrificing so much to make sure too much pressure doesn’t fall on the residents, and not only are his efforts being ignored, she’s actually trying to call him out for slacking off. What more can he do? Does she want him to actually live in the hospital?

“I suppose you think it’s beneath you to pull long shifts now,” Dr. Heo says, eyes glittering. “I suppose you’d rather risk a patient suffering because an exhausted resident isn’t able to give them proper care than lose a couple of hours’ of your precious sleep.” The words are accompanied by another poke to the forehead, hard enough this time to make his head knock back against the wall. It doesn’t hurt, but he doesn’t like it at all. She hasn’t gotten physical with him since he was a junior resident. He’s not supposed to need her discipline now. Shame curdles in his stomach, and he’s suddenly glad, after all, that the corridor is empty. At least none of the nurses or junior doctors are witnessing his humiliation.

“Chief Heo, that’s not fair,” he tries again. It goes against everything he's ever been taught to argue with her, but he’s not going to just let her bully him this time. It's not for his own sake - he has his family to think of. “I’ve been clocking more than eighty hours a week for the past two months. That’s far more than the residents are doing. I’m only asking for one night.”

“And what makes you think you deserve a night off, Jongdae?” Dr. Heo snaps. “Three deaths on your hands in the past few months, and you think you’ve got nothing to improve? You ought to be ashamed of yourself.”

Jongdae actually feels the blood drain from his face.

“I came under fire for our department statistics in the last managerial meeting, and you’re responsible for that. You better do all you can to become a better doctor, or I might have to re-look at those cases and see if there wasn’t some negligence involved.”

Jongdae feels sick. He knows she’s using this to get to him. He wasn’t negligent. His colleagues confirmed it. The M&M conference confirmed it. He’s just been unlucky. It would have been the same if any surgeon had taken those patients. But he can’t make the words come out, because despite him knowing all those things, something deep inside him agrees with Dr. Heo. It’s the part of him that remembers all too clearly the way the lives of those women slipped away beneath his hands. It’s the part of him that is torn apart by being unable to prevent death, because all he ever wanted to do was help bring life into the world. It’s the part of him that has taken his boss’s bullying for so many years that he accepts it as normal. Perhaps even as something he deserves.

“I’m sorry,” he says. Anything to get her away from him, get her glittering eyes out of his face, stop her from saying anything else about the lost patients, because if she does he isn’t sure that he’ll be able to hang on to the last shreds of his composure. He bows his head, lowering his eyes. Showing his submission. “It was disrespectful of me to argue. I know you’re balancing a lot of staff, and we don’t see the bigger picture from where we stand. I’ll take the shift.”

Triumph slides across her face. He sees it, but he doesn’t care. She wins, of course. She always does. Why did he even bother trying to stand up for himself? Right now, he’s just grateful that she’s taken a step back, so that he can breathe again.

“So long as you know,” she says. “Don’t force me to do this again. You shouldn’t need reminding of your work ethic, Jongdae. You’re not a junior anymore.”

He nods, humiliation flooding him. He stands still and silent, waiting until the clacking of her heels recedes back into the ob-gyn department and turns a corner. Then he flops back against the wall, closes his eyes, and takes a deep breath. It has been a long time since Dr. Heo managed to rattle him so completely.

He doesn’t have time to linger, though. He was on his way to a delivery before she interrupted him. He has to get to his patient. He takes another deep breath and passes a hand over his face. He shoves down frightened, ashamed Jongdae, and calls up confident, smiling Dr. Kim. Then he pushes away from the wall and walks down the long corridor and into the labour and delivery unit.

“Hi, Changying,” he smiles as he greeets the receptionist, and her face lights up when she sees him. “How are you doing today?”

“Hi, Dr. Kim,” Changying says, standing up to greet him. “It’s been a little busy, but we’re surviving!”

“Glad to hear it,” Jongdae says. “Could you tell me which room Lee Hyojoo is in?”

Changying doesn’t need to look at her computer. “Six,” she says. “Nurse Han is in there already.”

Jongdae thanks her and makes the short walk to his patient's room. Hyojoo has had all her prenatal appointments with him, both for this new baby and for her now 18-month-old daughter, so he knows her well. He knocks, and when a voice from inside calls for him to come in, he enters the room. Hyojoo is already lying on the birthing bed. She manages a smile for him despite the sweat on her face. Her sister is in the room with her, as well as Nurse Han, who has the entonox tube and the fetal monitoring equipment all set up. Her husband, a long-range fisherman, has been unable to get back to shore in time.

“Sorry to keep you waiting, Hyojoo,” he says, smiling back at her. “How are you doing?”

“Not too bad, considering,” she tells him, a little breathlessly. “But I’ll be glad when this is over.”

He nods sympathetically and assures her that she’s doing wonderfully and that it will all be over soon, and then gets a quick report from Nurse Han. Hyojoo has had an epidural and her blood pressure is within safe limits. The baby’s heartbeat showing on the monitor is 140, also normal for labour. Everything looks fine to go ahead with a l delivery, and relief slips through him. Emergency C-sections have become the subject of his recurring nightmare, and he takes nothing for granted these days, not even healthy mothers who have had perfectly normal pregnancies with no warning signs.

Half an hour later, his nightmare comes alive. Hyojoo, in the middle of pushing, suddenly sits bolt upright, gasps, then flops back on the bed. Her eyes are closed, she's completely limp, and when Nurse Han tries to awaken her, she doesn't respond. Seconds later, she begins to have a grand mal seizure.

Jongdae’s heart starts to bang hard against his ribs. Chills of horror crawl down his skin. No, he thinks, even as he’s leaping to assess her. No. Not again. This cannot be happening again.

“Call a code OB,” he tells Nurse Han. It’s the obstetric emergency code. He keeps his voice calm, keeps his terror hidden. He has to. He is the surgeon in charge and he simply has no other choice. Hyojoo’s sister backs away as staff begin to flood into the room. The anaesthesiologist supports her airway with oxygen via facemask. The seizure stops twenty seconds later, and Jongdae takes Hyojoo's vital signs, forcing himself not to rush so he doesn’t miss anything, while the anaesthesiologist swiftly intubates. He must be calm and clear-headed and in control. Hyojoo's pulse is racing, blood pressure low, oxygen sats dropping, and the fetal heart rate is falling fast, way too fast, dropping from a healthy 140 to a distressed 80 in seconds. Bad. Very, very bad.

Jongdae thinks fast while the resuscitation team stands by. He’s sure Hyojoo is going to deteriorate further. She’s going to arrest, the signs are all there, but why? There are signs of haemodynamic instability too, and his mind races as he continues to assess her.

“What was the epidural dose?” he asks Nurse Han, but the answer she gives him is well below the maximum usage guidelines. Unlikely to be local anaesthetic toxicity. The seizure only lasted twenty seconds, so not pre-eclampsia. No signs of anaphylaxis, none of cerebral haemorrhage...

The fetus is in acute distress, heart rate dipping right down to 70. Seconds later Hyojoo arrests, as Jongdae knew she would. The resuscitation team displace the uterus as best they can and start chest compressions, and Jongdae knows he has to make a decision, right now, or both mother and baby are going to die. He could use forceps to deliver the child lly and avoid the additional surgical and anaesthetic risks, but a forceps delivery has a risk of failure, and neither Hyojoo nor her baby have time to waste.

“I’m going to do a bedside C-section,” he announces.

The equipment is rushed to him. He does the C-section while they’re still performing compressions. He makes his cuts with practiced ease, lifts out a baby boy and hands him to the first pair of hands that are held out, not even seeing the staff member who takes him as he goes in to remove the placenta.

“I have a radial pulse on the mother,” someone calls, and another voice reads out the recovering numbers of her blood pressure. Hyojoo’s heart is beating again. Jongdae hears the cawing cry of a newborn, and, thank God, the baby is alive too, but he’s not done yet. Hyojoo is still in danger. He doesn’t know what caused her seizure and cardiac arrest, but what he does know is that the uterus hasn’t contracted after delivery. It's uterine atony, the leading cause of severe blood loss during C-section, the blood vessels that were attached to the placenta bleeding freely instead of being closed off by the contraction of the uterus. If the drugs to combat the atony don’t work, Jongdae needs to be ready to do an urgent hysterectomy, or she’s going to rapidly bleed out.

“Transfer her to the OR and get me an assisting obstetric surgeon,” he snaps, too stressed to speak politely anymore. In the labour unit's operating room he gives methergine and intramyometrial prostaglandin and everything else he can think of, but the uterine atony does not resolve, and as soon as his second-year resident shows up they’re straight into an emergency hysterectomy. It’s bloody and messy and surgical assistants are squeezing the blood bags to speed up the transfusions, erythrocytes and fresh plasma and platelets and cryoprecipitate, a desperately attempt to keep enough blood in her system to keep her alive. Jongdae feels like he’s standing in a wind-tunnel, all their voices ripping around him, all his senses on high alert. Blood, blood is everywhere. Why is there so much blood? There shouldn’t be this much. She’s not clotting properly. Coagulopathy on top of everything.

Usually he can narrow down his focus intently while he’s performing surgery, but today he hears everything, sees everything. He’s wide open to every input, and his mind keeps on racing through differential diagnoses. He discusses them rapidly with Nara across the surgical table, using her to bounce ideas off, the feedback from the other doctors and nurses in the OR watching monitors and taking clinical readings all giving him clues, until he’s excluded everything else, and there’s one thing left.

“Amniotic fluid embolism,” he says, fingers not pausing for a second as he swifty ties sutures and breaks his sentences with instructions for the theatre nurse to cut the thread.

“What?” Nara has never heard of it. Not surprising. It’s so rare that it might be seen only once in a career, but Jongdae has been reading up on maternal mortality lately, for obvious reasons.

“The amniotic fluid surrounding the baby in the uterus has entered the mother's bloodstream,” he tells her. “It’s rare - incidence of two in ten thousand - but often fatal, and it causes coagulopathy and haemorrhage, that’s why we’re seeing so much blood. What’s the collection amount?” he asks an assistant.

“Close to 3000 ml,” he’s told, and he nods grimly. It’s only the rapid transfusions that are keeping Hyojoo alive. If they hadn’t been so quick earlier she’d already have bled out.

“Call the ICU and ask them to send an intensivist here, please,” he says to the theatre nurse. The ICU team will manage this condition, but he wants to confirm his diagnosis with an intensivist first. Dr. Lee Eunsook turns up ten minutes later, just as the hysterectomy is finished. Jongdae leaves Nara to close Hyojoo up and checks on the progress of the transfusions and administration of drugs to treat the coagulopathy before allowing himself to turn away and give his attention to Dr. Lee. She isn’t scrubbed in, so she waits in the doorway as Jongdae comes over. She smiles at him, and somewhere amidst his state of sky-high stress, Jongdae appreciates it.

“I think this is amniotic fluid embolism,” he says, “but I’d appreciate a second opinion. Would you mind if I run my differential past you?”

“Of course,” Eunsook says. “Go for it.”

He talks her through the differential. About halfway through, his hands start to shake and his voice begins to jerk between words, but he keeps talking anyway. He’s gone beyond the point of caring what Eunsook thinks, or what anyone thinks really, and he’s done all he can for Hyojoo, so he doesn’t have to keep it together anymore. When he’s explained everything, as well as the need for the emergency hysterectomy, Eunsook nods.

“That all makes sense to me. I agree with the diagnosis of AFE,” she says. “I’ll admit her.”

A trembling breath leaves him. Relief that Dr. Lee agrees, that he hasn’t missed something, given the wrong drugs, done an unnecessary surgery that has just rendered Hyojoo irreversibly infertile. Relief that behind him the ECG monitor still shows a pulse, and the blood pressure is stabilizing. He stumbles away to lean against the OR wall. Hyojoo is not out of danger, but she has a chance. They’ll take care of her in the ICU. She’s out of his hands.

“Just give me a minute,” he says to Eunsook when she hesitates beside him, obviously wondering whether he’s okay. He finds a reassuring smile to send her, which drops from his face the second she’s gone. Hyojoo is transferred, doctors and nurses leave, cleanup begins, and Jongdae leans against the wall and watches it all.

He feels shell-shocked. Hyojoo is alive. Her baby is alive. He doesn’t have another death on his hands. He should be rejoicing, so why does he feel like crying? Everything feels so tight and messed up and pressed down inside him, curled and full of tension like a coiled spring, and he’s scared it’s going to snap when he least expects it. He’s already lashed out at those interns. He’s lashed out at his own son. He’s scared it’s going to happen again. Perhaps it’s a good thing, after all, that he can’t go home tonight. What if he snaps at Ahreum next, or Chorong, or, God forbid, little Mari?

Jongdae has never felt this stressed out in his life and he just doesn’t know how to process it. Maybe it’s because he’d usually talk it all out with his friends as soon as something bad happened, but he hasn’t been able to do that for months. His friends are dealing with problems far worse than his. How can he burden them with his own silly issues? They need him to be there for them. They need him to be strong, to be the listener, the one who helps. And Jongdae wants to be. He really does. He’d do anything to help his friends. It’s just the way he is.

The cleaning staff need him out of the OR. Jongdae grasps for the tattered shreds of his composure, de-gowns, and scrubs out. When he gets back to his office he takes out his phone to call Ahreum.

“I’m so sorry,” he says when she makes a sad little sound. She sounds so disappointed, and it fills him with unhappiness and guilt. “I really wanted to come home tonight, but you know how it is.” She does know. She knows Chief Heo is difficult, though he's never told her the full extent of it, and she knows the department is understaffed and that he worries about the workload on the residents. She understands, but she’s still sad, and he’s just as sad as she is.

“The kids miss you,” she tells him, and the guilt curls him up even tighter.

“I miss them too,” he says. “Can I talk to them quickly?”

“Chorong and Bodeul are at taekwondo,” she tells him, “but you can talk to Mari.”

He gets an adorable, confused babble from Mari, who squeals with delight when he switches to a video call app and tries to press her chubby hands through the screen of Ahreum’s tablet at him. Jongdae's heart twists with longing even as he laughs and taps at her nose and tells her he loves her.

“Love daddy,” Mari says back, and Jongdae thinks he’s really going to cry if he’s not careful. He knows it’s just a stress reaction. He’s overtired and his emotions are too close to the surface. He wishes with all his heart that he could just go home and hold his baby in his arms and kiss her curly head. But he can’t, and he still has patients to see, so with a heavy heart he gets a hold of himself and says a last few words to Ahreum. Now that the video is on, she can see his face, and her forehead pinches.

“Darling, what's wrong?” she asks. “You look…” she can’t seem to immediately find the right word, and Jongdae quickly jumps in before she can come up with “exhausted” or “stressed” or “upset”. He doesn’t want those words vocalised. Not by her. Not about him.

“I'm fine,” he says quickly. “Just the usual stuff. Long night, long day, you know how it goes. I promise I’ll be off tomorrow morning, and I’ll make it up to you.”

“You’ll sleep,” Ahreum says, “if I have any say in the matter. Which I do.”

Jongdae laughs noncommittally, tells her he loves her, and ends the call. He has patients to see, and a long night ahead of him.

---

Joonmyun stares at the echocardiogram on the computer screen in front of him. Beside him, Dr. Ahn is studying the images with equal intensity. It's a case of aortic regurgitation, very obvious in the images in front of them.

“He needs an aortic valve replacement. A repair isn’t enough,” Joonmyun says. Dr. Ahn nods. They agree on this so far. The rest of the treatment, however, is the reason they’re stuck in this small dark office together.

The cardiologist turns from the screen to look at Joonmyun. “Giving him a metallic valve is going to put him on anticoagulants for the rest of his life, Dr. Kim. He’s only nineteen. The risk of hemorrhaging won’t diminish with age.”

She scrolls through the images again. Park Jonghyun has a con heart defect that has gone unseen until he suddenly collapsed during a soccer match. While it may have been easily repaired when he was a child, the only option now is replacing the aortic valve. Finding the right replacement isn’t as easy as it may seem, though. Every option comes with a multitude of benefits and a whole host of disadvantages.

“I know, but a tissue valve isn’t going to last him much more than ten or fifteen years. By then it’ll start degenerating fast and he will eventually need a new one. Open heart surgery isn’t exactly risk-free.”

They look at each other, then back at the images. The small wall clock ticks away the seconds.

“I wouldn’t recommend a tissue valve for anyone under the age of sixty-five,” Joonmyun says eventually, breaking the silence.

“I see your point, but I don't like the idea of putting such a young kid on anticoagulants for the rest of his life."

“He might not be able to roughhouse the way he’s used to on anticoagulants, but I dare say it’s better than dying,” Joonmyun says. “Metallic makes a lot more sense in this case. We can give the kid his life back for the most part with a metallic valve.”

It feels a little like negotiating, but they have to agree on the best course. Dr. Ahn will be responsible for further treatment and for correcting the medication when Joonmyun is done, so he can’t just do what makes most sense to him surgically. Dr. Ahn sighs and reaches for the computer mouse to close the echocardiogram.

“Okay. Let’s go with the metallic aortic valve,” she agrees, and Joonmyun silently celebrates his small victory. The walk from the