Chapter 53

Chapter 53

"Professor, how many deliveries would we need at minimum?"

Gain answered with a question instead.

She needed time to think.

There were around one hundred students in a third-year medical class.

Clinical rotations were usually divided into groups of six to eight.

An OB-GYN rotation lasted two weeks.

A six-person group would probably come every two weeks, three or four times during a semester.

That was how it had worked when Gain was a student.

"During those two weeks, each group should at least be able to attend one vaginal delivery and one C-section."

Kim Dohyeon looked at Han Seongyeon.

"How many deliveries did that training hospital we cut ties with have?"

"Two per month."

"Then you should have more than that."

If the next semester started in early September, Gain had around three months to prepare.

To become an official external training site, they needed qualified supervising specialists, enough cases, proper facilities, and student-safety protocols.

"They won't be there for the entire two-week rotation, right?"

"Twice a week for two weeks."

Kim Dohyeon explained.

"Monday and Tuesday mornings, or Wednesday and Thursday mornings."

Medical students needed to observe prenatal visits, ultrasound, pelvic examinations, and deliveries.

Prenatal visits and ultrasounds were easy enough to provide.

Pelvic examinations too.

But if the students did not see an actual delivery, there would be little point in sending them all the way there.

Gain pictured the clinic layout.

They were currently expanding into the neighboring unit to build the delivery room and nursery.

Examination Rooms One, Two, and Three were already occupied.

They would need a changing room for six students.

And some sort of teaching room where she could give instruction.

We planned the nurses' station with extra lockers and space.

They were planning to hire more people once the number of deliveries increased.

Maybe the students could temporarily share that space.

If all the students were women, perhaps.

But medical-school classes were usually seventy to eighty percent male.

"Do you really have room for students?"

Han Seongyeon interrupted.

"You only opened half a year ago and you're just now starting deliveries."

She had stayed silent ever since Kim Dohyeon scolded her earlier.

This was the first time she had spoken.

Gain smiled.

"Then we'll make room."

"There's a space beside the on-call room that we were going to use for storage."

"We can divide it into separate men's and women's changing rooms."

"One extra partition wall and lockers will be enough."

Kim Dohyeon laughed.

"Perfect timing."

"Thanks to you."

Han Seongyeon shrank slightly and moved as if trying to hide behind another fellow.

Gain ignored her and mentally crossed items off her list.

If Gain was appointed as an adjunct clinical professor, she could supervise the students herself.

For safety management, she could simply obtain the university's requirements and meet them.

Gain was confident in that area.

Jo Eunjae's infection-control standards were already comparable to those of a university hospital.

Their general safety protocols were also excellent.

And the most important thing.

Patient consent.

Patients at university hospitals were used to residents, interns, and students.

But if medical students suddenly appeared in a private clinic, some patients might be startled.

Gain would need to explain things properly and obtain clear permission.

"Professor, I really want to do this."

Gain smiled.

"But we haven't actually started deliveries yet."

"I'd like to try it first, then contact you again."

"By when should I give you an answer?"

"By the end of July."

Kim Dohyeon agreed immediately.

For a brief moment, Han Seongyeon's expression twisted.

By the time Kim Dohyeon looked toward her, she had already returned to a polite smile.

At the back of the group, two medical students in brand-new white coats whispered.

"Does that mean we might rotate at her clinic next semester?"

"My OB-GYN rotation is next semester."

"I'm curious. Where is it?"

Kim Dohyeon gathered the group of doctors and students and headed toward the next room.

Rounds had to continue.

"Who's next?"

"A thirty-two-year-old patient who had a C-section yesterday."

Their voices faded.

Jo Eunjae turned toward her aunt.

"Aunt, it might not be cancer. It could just be an ovarian fibroma."

"A fibroma isn't cancer?"

"No."

Eunjae's voice brightened.

"If that's what it is, you won't need chemotherapy!"

"I wasn't going to take chemotherapy anyway."

"Aunt!"

Eunjae hurriedly listed what sounded like a hundred reasons an ovarian fibroma was better than cancer.

She sounded like a salesperson advertising fibromas.

"The ascites will go away quickly."

"You won't need chemo, so your hair won't fall out."

"And I know a really good wig shop, but you won't even need the wig."

"I said I wasn't going to do chemotherapy."

"That's what you think."

Gain laughed quietly.

"I'll head back first."

"Doctor, thank you so much."

"Thank you, Doctor."

The aunt bowed her head.

The niece bent at the waist.

Jo Eunjae practically bowed at a ninety-degree angle.

Gain quickly left.

She wanted to give the aunt and niece some time alone.

On the way to the elevator, she felt divine power swell warmly inside her.

The most important thing is survival rate.

Stage-three ovarian cancer had only around a forty-percent five-year survival rate.

Six out of ten patients died.

But a fibroma was over once it was removed.

Gain smiled as she left.

I can't supervise students only outside clinic hours.

If she taught students, she would inevitably see fewer patients.

And adjunct clinical professors don't get paid.

The title sounded impressive.

But the university did not pay a separate salary.

To become a training site, Gain would need to handle more deliveries.

Yet the more deliveries she did, the more money the clinic lost.

Their current fixed expenses were already significant.

Taking students would create even more costs.

Gain pressed the elevator button.

Still, I should do it.

Right now, her entire relationship with Second Campus Hospital depended on Kim Dohyeon.

Even obtaining emergency O-negative blood through their blood-bank partnership would probably have been impossible without his help.

He accepted her transfers without hesitation.

He spoke well of her.

Becoming a clinical training partner would finally give Gain a chance to repay him.

Not immediately, perhaps.

But over time, the two institutions could work as equal partners.

She was going to handle deliveries anyway.

She was also going to open an infertility clinic.

Money isn't the most important thing right now.

"What's important is strengthening our relationship of trust with Hanguk University Second Campus Hospital."

Gain's thoughts returned to the on-call room.

Originally, I was going to divide part of that storage space so the night doctor could rest there.

Now that space is gone.

Should she put a folding bed in the room where she currently lived?

But the thought of letting someone into her personal space made her slightly uncomfortable.

During internship and residency, everyone had slept in bunk beds in shared duty rooms regardless of gender.

But this was different.

This was now her private room.

I'll think about it.

***

That night, in the duty room at Hanguk University Hospital, OB-GYN fellow Kang Taehun woke to a phone call.

"Dr. Kang Taehun. This is the delivery room. You need to come see the patient in Room 302."

"What now?"

"Third-degree perineal tear."

The call ended.

"Seriously? You're calling me for this again?"

He had already gone down an hour earlier.

This was the sixth time he had been awakened tonight.

Perineal tearing during vaginal delivery was common.

A first-degree tear involved only the mucosa and skin.

A second-degree tear extended into the muscle.

A fourth-year resident could repair those independently.

But a third-degree tear involved the anal sphincter.

At that point, fourth-year residents did not touch it.

Not because they physically could not.

Because they refused to take responsibility.

If the repair was misaligned, the mother could suffer fecal incontinence for the rest of her life.

Because of that weight, third-degree tears and above were handled by fellows or attending physicians.

Even at dawn.

"Ah, damn it."

Kang Taehun swore as he pulled on his coat and went down without even washing his face.

The elevator was empty, so he reached the delivery room quickly.

The patient in Room 302 was a first-time mother.

She had delivered a 3.9-kilogram baby.

The perineum had torn deeply toward the anus.

Kang Taehun put on gloves and pulled the surgical light into position.

The bright light illuminated the wet tissue.

The tear began along the posterior vaginal wall and extended downward before angling toward the anus.

The mucosa was pale peach, like the inside of a ripe fruit.

Deeper inside, a darker red layer was exposed.

The perineal muscles.

Their fibers had split apart on both sides.

The torn surfaces were ragged from being stretched until they ripped.

The metallic smell of blood rose from below.

Mixed with it was the smell of amniotic fluid.

Farther back, another odor lingered beneath both.

Kang Taehun breathed shallowly.

"Suction."

The nurse placed the tip.

Collected blood disappeared with a wet sound.

The field cleared briefly before fresh blood slowly seeped back.

Immediately after childbirth, the perineal tissues bled easily.

Nothing unusual.

Kang Taehun coated his index finger with gel and inserted it into the anus.

Warm.

The rectal mucosa softly wrapped around his finger.

He placed his thumb outside and palpated the tissue between them.

Normally, the sphincter felt like a rubber band tightening around the finger.

Along the left side, he found that tension.

Then it abruptly disappeared.

From there to the right side, there was only soft tissue.

"Definitely third degree."

The rectal mucosa itself was intact.

His fingertip did not catch on any hole.

Nothing abnormal smeared his glove.

At least it was not fourth degree.

That was something.

The problem was that the severed sphincter ends were no longer sitting where they belonged.

The anal sphincter was a muscle that constantly maintained tension.

Once cut, both ends snapped backward.

Like cutting a stretched rubber band.

The ends recoiled into the surrounding fat.

All he had to do was search with forceps, find both ends, pull them out, and suture them together.

Once found, they were easy to recognize.

Brownish-red bundles of muscle.

Unlike fat, they had visible fibers and resisted traction.

But tissue after delivery was swollen and red.

Even yellow fat was soaked with blood and looked reddish.

Visual identification was difficult.

You had to grab something with forceps and pull, judging by how it moved.

Gain used to do this every time.

He found the left end relatively easily.

The right one would not appear.

Kang Taehun picked up the forceps again.

Then put them back down.

If he searched once more, he might find it.

He could retract more fat and dissect outward.

But then he would have to extend the incision.

Add more anesthesia.

And even then, if he still could not find it, another thirty minutes would disappear.

The clock showed 4:20 a.m.

Rounds preparation started at 6:30.

At eight, he had to stand in front of his uncle.

"...This is enough."

He had seen cases where things settled after the swelling went down.

Even imperfect repairs sometimes looked perfectly fine months later.

The human body had a way of healing once things were stitched together.

Third-degree tears have bad outcomes anyway.

Immediately after delivery, everything was swollen.

The repair would look acceptable.

The patient would hurt for a few days, then go home.

At her one-month follow-up with Kang Juhan, she would probably say she was fine.

But months or years later, the tissue might loosen.

At first, gas might escape unexpectedly.

Later, loose stool could begin leaking.

She might stop exercising.

Avoid long bus or car trips.

Always check where the nearest bathroom was.

But plenty of patients complained of gas leakage even after textbook-perfect repairs.

The textbooks themselves said so.

So there was little chance she would come back and blame Kang Taehun personally.

That was enough.