Chapter 48
Ring... ring...
Gain counted the tones.
She hung up after the fifth and immediately called again.
Ring... ring...
No answer.
Her heart seemed to drop.
Still, Gain did not panic.
She glanced to the side.
Her house-call bag was already packed.
I know the address.
Fortunately, there were two other doctors here now.
If no one answered this time either, she planned to go there herself or send 119 directly to the address.
On the third and final call, someone answered after the second ring.
"Hello?"
It was Jihoon.
His voice sounded frightened and confused.
"Jihoon, this is Im Gain. Could you put Eunchae on the phone?"
"Um... right now..."
His words broke off.
Gain heard rustling in the background and a low groan.
"Her face suddenly went white and she collapsed. She's lying on the sofa now."
Gain tightened her grip on the phone.
"Is she conscious?"
"Yes. Her eyes are open, but she can barely speak."
"What about the bleeding? Has it increased?"
"Yes. Much more than earlier..."
Gain's voice became firm.
"Jihoon, your address is Somang-dong, correct?"
"I'm calling 119 to your home right now."
She continued quickly.
"I'll tell them this is postpartum hemorrhage and that her hemoglobin is 7.8. I'll ask them to bring her to Hyundai OB-GYN because we have blood stored here and can transfuse her immediately."
"Raise her legs above the level of her heart."
"I'll be ready when you arrive."
"Yes! Yes!"
The call ended.
Beside her, Jo Eunjae was already making the emergency call.
"Joy City, Gippeum-dong, Jugong Apartments, Building 101, Unit 1204."
She spoke clearly.
"Thirty-five-year-old woman with acute postpartum hemorrhage. Hemoglobin 7.8. Please transport her to Hyundai OB-GYN Clinic."
Thirty-four days after cesarean section.
The incision Gain had checked earlier had clearly healed well.
The lochia was brown.
No fever, so this isn't endometritis.
She needed to examine the uterine cavity with ultrasound and identify the source of bleeding.
Could it be retained placenta?
But Professor Kim Dohyeon had performed the surgery at Hanguk University Hospital.
There was no way someone of his experience would leave behind a large piece of placenta.
The ambulance siren grew louder as it entered the market alley.
Gain had already thrown open the procedure-room door.
I should have kept her here and checked more carefully earlier.
When Eunchae had mentioned mild abdominal discomfort during the appointment, Gain had assumed it was an ordinary postpartum symptom and sent her home.
She should not have.
Rattle...
The moment the stretcher entered, the smell of blood filled the room.
Red had spread beneath the blanket.
Jihoon rushed in behind them with Iseo in his arms.
His face was white.
"Blood pressure 90 over 60! Pulse 110! She's on oxygen!"
The paramedic shouted.
Gain moved to the bedside.
"Eunchae, it's me. Can you hear me?"
Eunchae's eyelids trembled weakly before finally opening.
"Doctor..."
There was almost no strength in her voice.
Jihoon stood beside the railing.
He held Iseo with one arm and gripped the bed rail with the other.
His hand was shaking.
"Eunchae. Eunchae, stay with me."
His voice broke.
He tried to take his wife's hand, but Lee Seyoung stepped in to start an IV line, forcing him back one step.
With the baby in his arms, he could not move freely.
He could only stand there helplessly.
"Start normal saline through an 18-gauge line, quickly."
Gain pointed.
"Left arm first. Hartmann's solution in the right."
"And we're transfusing immediately."
For emergencies, they inserted a large-bore IV and started normal saline.
Fortunately, Lee Seyoung was fast.
Even though Eunchae was swollen and her veins were difficult to find, Seyoung got the line on the first attempt.
While Jo Eunjae connected the monitor leads, Gain was already wearing gloves and palpating the abdomen.
The uterine fundus is soft.
And it's about two fingerbreadths higher than it should be.
Gain frowned.
More than a month had passed since the cesarean.
By now, the uterine fundus should have descended into the pelvis and no longer been palpable through the abdomen.
It had been fine earlier.
If she could feel it now, something inside was pushing the uterus upward.
"We're going to transfuse the two emergency units of O-negative blood we have stored."
They were two precious units Gain had secured when Hyundai OB-GYN partnered with Hanguk University Second Campus Hospital and signed a blood-supply agreement in preparation for opening the delivery unit.
This was exactly the situation they had been saved for.
"Eunchae is O-positive."
Jihoon's voice trembled.
Lee Seyoung explained quietly,
"It's an emergency."
"We'll start with O-negative blood, which can be used before full compatibility testing, then confirm her blood type again with the rest of the labs."
Jihoon stepped toward the foot of the bed, still holding Iseo.
The baby began fussing at the unfamiliar sounds.
He patted her back with one hand but never took his eyes off his wife.
"She said her stomach hurt a little earlier."
His voice shook.
"I thought it was just because she recently gave birth."
His eyes were red.
Gain looked at him.
"Jihoon, right now we need to find the cause first."
"Take the baby outside for a moment."
Then Gain pulled over the ultrasound machine.
Her hand moved quickly as she squeezed out gel.
The moment she placed the probe against Eunchae's abdomen, the monitor came alive.
An irregular mass of shadow appeared.
Gain activated Doppler mode.
Red and blue signals flashed and swirled inside it.
There's blood flow.
This isn't just a blood clot.
The tissue itself has vessels attached to it.
Gain organized her thoughts.
She rescanned the mass, carefully following its borders and blood-flow signals.
Retained placental tissue.
That's the most common cause and it fits the imaging best.
There was clearly living blood flow on Doppler.
One month after delivery.
A localized, irregular mass.
It was a classic picture.
But Professor Kim Dohyeon had personally performed the surgery.
Someone of his skill should not have missed tissue this large.
Did he make a mistake?
The question remained.
But determining Eunchae's current condition came first.
Gain examined the image more closely.
The irregular borders also raised the possibility of a placental polyp.
Then she shook her head.
A placental polyp forms when retained tissue slowly fibroses and becomes covered with thrombus over time.
The timing doesn't fit.
Placental polyps usually formed over weeks to months.
This was only a little over one month after delivery.
Too early for the tissue to have fully organized into a firm polyp.
Could it be a coagulation disorder?
She could not completely exclude a systemic problem with clotting.
Gain looked over Eunchae's inner arm.
"Eunchae, could you show me your gums?"
Eunchae groaned and opened her lips slightly.
She could still understand instructions.
That meant she had not reached the worst stage yet.
And without knowing the cause, Gain could not recklessly pour divine power into her.
Still ready to use it if Eunchae suddenly worsened, Gain examined the gums.
No.
With a systemic coagulation disorder, tiny hemorrhagic spots should be visible on the gums and mucosa.
There should also be bruising spreading around the IV sites Seyoung had just placed.
Gain should have noticed that immediately.
But because a patient she had confidently sent home had returned bleeding, she had become anxious and overlooked something obvious.
There's no sign of systemic bleeding.
Calm down, Gain.
She steadied herself.
The first unit of blood was already running.
So far, Eunchae's blood pressure and temperature had not suddenly changed during transfusion.
Her respiratory rate was also gradually slowing toward normal.
And there was an obvious lesion on the screen.
It's exactly what it looks like.
Fortunately, the cause was something with a clear solution.
"It's retained placental tissue."
Gain felt relieved.
"We'll remove it with suction curettage under ultrasound guidance."
She looked toward Seyoung.
"Nurse Lee, send PT, aPTT, and fibrinogen too. If the bleeding doesn't stop properly, we need to rule out a clotting problem."
Lee Seyoung nodded and transferred the drawn blood into specimen tubes.
