A Doctor's Clinical Diary 2 - The Smallest Teacher I Ever Met.

Chapter 1. Today, the Wind in the Chest

I walk down the old corridors of the hospital again today. With every step my feet take on the floor, there is a sound that cuts through the air, where the cold smell of metal and the scent of antiseptic are mixed. These sounds fall like notes between the lines of a poem, leaving a small rhythm in my heart. When the white paint on the wall gets a little wet with sunlight and glistens, I am reminded of a narrative.

There is always a flow of blood in a corner of our lives. That is why I always think, who protects this small road that keeps the blood flowing, and what is the shadow that threatens this road if there is one?

Today's thought comes to me like a special symphony. In the corridors of this hospital, doctors, nurses, technicians, and families are all mixed together. The stories etched in the chest change little by little every day. This story is not a simple record of surgery or a list of diagnoses. It is a family's wait to watch a child grow, and the traces of time my hands and heart have walked together for 15 years.

As a doctor, I go back and forth between cold judgment and, perhaps, human compassion, approaching the deepest part of this life. Yet I am always careful. This is because on the road named medicine, I can cause new pain instead of relieving someone's suffering. Today's conversation has not yet begun. However, the child's breathing sounds flowing from outside the hospital room and the parents' quiet whispering already fill this space. This child's family looks at a hand that is still young and trembling and support each other. Fear seeps into their eyes, but at the same time, a streak of hope shines. This is because this child's heart is at the core of the many possibilities before us and the center that will lead the rhythm of life to come. Today's encounter begins like that. It approaches slowly, but it is an encounter that will never be forgotten.

I open a space in my heart with careful breathing, as if I were looking into this child's heart for the first time. The name Congenitally Corrected Transposition of the Great Arteries, or CC-TGA, may be unfamiliar, but at this moment, I am already ready to listen to this child's name and story. CC-TGA has a unique structure called double discordance, in which the atrioventricular connection and the ventriculo-arterial connection are simultaneously mismatched. Therefore, the direction of blood flow appears superficially normal, but in reality, the rules that dictate "how to move and where to go" change. As if flipping through a child's thick notebook, I slowly recall the structural picture surrounding this child's heart: the path where the right atrium flows to the left and the left atrium to the right, where the aorta to the systemic circulation is located, and in what direction the pulmonary artery flows. Normal life can continue only if everything flows in a single rhythm. However, this rhythm is sometimes slow and sometimes broken. Each time, the heart is redesigned with small intentions to protect this child's life.

I recall the past 15 years. During this time, I have observed the patients' breaths, the smell of blood, and the countless subtle changes a small body makes every day. Some patients have come close to the end of their lives, while some children have begun to breathe again with an unexpected light of possibility. All these experiences make me more humble. A doctor is just a human being in the end, and the life of one person touched by our fingertips can be a small miracle that changes its form over decades. So today, whenever I look at this child's chest, I try to accept this story slowly but honestly, as if writing a poem. The cold sound of hospital machines also sounds different today. The whispering sound of the numbers on the monitor sounds like an omen of what kind of path this child will walk in the future. I wonder if the fear and miracle that this child's family will experience will make the air in this room more moist.

The purpose of medicine is to live a deeper and wider life. The combination of small wills to change the flow of blood makes each day of the child's life a little easier to breathe. Those wills flow out through the windows of this room, and the outside wind is absorbed back in. Of the many paths this child will encounter as they grow up, we do not know which one will bring true rest and hope to this family. But what is clear is that this child's story has begun today. This beginning is very small and humble, but it portends the countless lights and shadows that will fill all the pages to come.

I offer a small prayer deep in my heart. May this child's heart find stability and courage through the warmth of my touch and voice, and may this family hold hands tightly and endure this long journey together. Even in the cool shadow of CC-TGA, the warmth of life is always alive, and that warmth pulsates with this child's small heartbeat.

Today, I walk along this wind. I follow the story told by the wind in the chest, and the traces that this child's name and face will leave. And I hope that someday, when I leave this room, this child will be able to greet the people they will meet again with a bright smile. That would be the most precious miracle we should build on this path.

Chapter 2. The Moment I Met CC-TGA

As soon as I entered the hospital room, the child looked at me. It was a calm and clear gaze, and below it, a small and thin nose and hand were trembling slightly. The monitor light was faintly illuminating the screen, and the heart rate graph flowed in a steady wave. A small wind blows inside me even in this stillness. Today's meeting feels like the beginning of a decisive chapter that will determine in what direction a child's life will flow, beyond a simple moment of treatment and diagnosis.

The name CC-TGA, which the medical staff mentioned, was unfamiliar and frightening at first. The word "double discordance" left an echo in my head. The fact that the right ventricle anatomically takes charge of the systemic circulation and the left ventricle sends blood to the lungs made me think about how complex the child's body was and how long it had endured. On the surface, the blood flow seems to be "normal," but the rules of this flow are out of place in an unseen way. It felt like an orchestra skipping a part of a score, where the heart tried to keep the same rhythm every time, but important notes were missing.

The child's mother sat down quietly next to me. Her hands were trembling, and at the same time, the traces of her efforts to not lose her composure remained in the fatigue of her wrists. "Doctor, I was so surprised when I first heard that my child was growing up so differently. But now, I feel like this small heart has become the center of our family."

Her tone was mixed with both fear and affection. Perhaps, in the face of this child's growth and the many choices to come, this family would have the most more worries than anyone else outside. The child's name was still young, but it had already become the center of our hearts. Despite being five years old, her eyes were mature, and the words that flowed from her small mouth sometimes left a smile as if she were comforting herself. "Mom, Dad, am I okay?" That question flowed very quietly from her lips, and the room was filled with a very short silence at that moment. There was no fear mixed in the child's tone. Rather, curiosity was more prominent.

When she asked, "Do I need surgery?", I carefully nodded. "To find the best way, let's think about it together. Sometimes you will see not just one way, but several. What is important is to look together at which path will leave the most complete brightness in the child's life."

Before starting the conversation, I examined the child's chest. The way her heart beat was very unique. The right ventricle moved slowly as if taking a breath, according to the systemic circulation. But this endurance is not forever. Whenever the burden increases, the right ventricle may show a decrease in function, and there may be a risk of tricuspid valve regurgitation. All these possibilities were like a shadow that always moved together in my mind, even if they didn't actually happen in the child's small chest.

The child's father sighed. "Doctor, I think our child is doing well now. But I am worried about the future. What choices will my child make as they grow up, and is surgery really necessary for our child?" His voice was filled with affection. As I heard that question, I reaffirmed one thing. A doctor must be able to tell the truth, but it must not incite fear. The truth is refined over time, a path opens through dialogue between the family and the doctor, and in the end, it must be gathered in a direction that improves the child's quality of life.

"That's right. This path is not simply determined by whether or not to have surgery. There are also cases with no symptoms, and for mild cases, consistent follow-up can lead to sufficient survival and growth. However, in this child's case, the burden created by double discordance may become more prominent over time. So our team will carefully observe the child's current condition and try to imagine various scenarios together," I continued slowly. "What's important is that even when this child grows up and chooses their own life, there is an environment where the people around them support them rationally and emotionally. Surgery may not necessarily be the best option, and conversely, it may be a decision that brings about a big change. But all of this only finds meaning in the process of standing by the child's side, listening to the child's voice, and discussing it with the family."

At that moment, the child held out her hand. When the very small hand touched my wrist, I could feel its warmth. The child's skin was not cold. It was still full of life, and I could see a subtle tremor of hope between her fingers. "Doctor, I want to go to school. I want to play soccer with my friends, draw, and sometimes share secrets with my friends."

That humble wish made the air in the room a little warmer. I saw hope spreading in the parents' eyes. The world still brings many uncertainties, but in this small conversation, the first step has already been taken. I sat deep in my chair and tried to bring the parents' and the child's gazes together.

"First of all, it is a priority to keep the current condition stable. We will monitor how the heart's function changes through regular ultrasound and MRI. In addition, monitoring is needed to detect complications such as arrhythmia or tricuspid valve regurgitation early. I also want to give a tip to the family. Let's not react sensitively to small changes every day, and let's find out what kind of management is needed together without disturbing the child's daily life as much as possible."

The child's eyes became clear. "Still, Doctor, I want to grow up to be pretty and happy. I want to play with my friends and look at the stars at night."

I couldn't help but smile at her words. The child's dream is simple. But that very simplicity is the child's strength. "Of course. The child's dream is always the priority. Our job is to organize all the necessary information and present all possible options fairly so that the dream can come true."

I wrote a few simple goals in my notebook. "1) Confirm the stability of the current condition, 2) Establish an early warning system for complications 3) Continuous communication with the family, 4) Balance the quality of the child's daily life and possibilities." The conversation was not long. But even in that short time, I felt that the child's life and the family's heart were approaching me more concretely. The wind in this room is not always cold. Today, this wind turned in a warm direction. It was a moment when we confirmed that the child's laughter was not a distant future, but a possibility that was beginning right here. And I once again held the weight of the responsibility of watching over this possibility in my heart. The first page of the journey of how this child's heart will follow this path was being written at this very moment.

Chapter 3. The Story in the Images

The story began with a small sound. As the cold air flowing over the hospital shelf seeped to my fingertips, I felt that the silence in the room was turning into a poem. The monitor light flickered, and heart-shaped shadows stretched long on the wall. Today, I am going to slowly follow how this child's story flows in the images, and what kind of emotional ripple occurs between us who are watching this story.

The guardians sitting in the chairs were holding each other's hands. The child was lying on a small bed next to bed, and her eyes were clear like a large lake. The low humming sound of the machine on the screen, combined with the stillness of the room, was like the sound of the wind seeping through the cracks in the window. At this moment, all the words seemed to float to the surface, and I decided to take a step back and observe the flow.

"Is this the heart?" The mother's voice first seeped low with a tremor. The question was simple. But worry and expectation were riding on it. "Yes, this small pulsation is this child's heart. But this heart does not work in the usual direction, so it flows a little differently from the heart that laypeople see." I answered quietly. My voice was calm, but a small anxiety seeped into my words.

The father slowly took a breath. "Is it true that this heart is responsible for sending blood throughout the body? Is it the most important pump in this child's body?" "That's right. This child's right ventricle is in a structure that is responsible for systemic circulation. You can think of it as the direction of the ventricle being reversed. Researchers call this 'double discordance'. The connection between the atrium and the ventricle goes in the wrong direction, but the blood flow often appears functionally normal. So cyanosis may not be obvious at birth." I tried to maintain a serious tone. But I also knew that the tone would not lessen the weight of reality.

"Will this eventually become a problem later?" the mother asked. Her voice was still careful, and a small glimmer remained in her eyes. "There is a possibility. The right ventricle may gradually lose function if it endures the burden of systemic circulation for a long time. Therefore, in addition to looking at the current condition with an anatomical image, it is important to pay close attention to the direction of blood flow and changes in pressure. Complications such as tricuspid valve regurgitation can occur, and this is a problem that gradually worsens over time. But right now, it's time to be on high alert so that this child can breathe comfortably and sleep well."

The child's clear-eyed light slowly seemed to cut through the air in the room. Curiosity, not a question, was shining more brightly in those eyes. The guardians were holding the child's hands together, and the child's hands were lightly placed on the guardians' hands. This small touch seemed to relieve the weight that was difficult to express in words.

"So do the images only tell the story of this moment? Or do they also show future possibilities?" the father asked again. His tone was calm, and there was an intersection of expectation and fear. "The images are just a window that shows the current structure. It doesn't determine the path of the future in advance. But through this window, it helps the doctor and the family think together about what choices to make, what possibilities to open, and what risks to prepare for." I pointed a finger at a spot on the screen. "This is the part that shows the location of the right ventricle in charge of systemic circulation, and these are the points where the aorta and the pulmonary artery meet, and where these big roads flow."

"By looking at that path, can you also predict if the child can run and play freely?" The mother's voice still had a cautious expectation. "It would be more accurate to call it a map of possibilities. A map tells you the way, but the path does not always end at the same speed. As the child grows, the blood flow also changes, and the form of treatment required can also change accordingly. So we monitor regularly and accept the story that changes little by little with each image." Those words meant that there was no definite answer yet. But everyone in this room had one sure duty. That is to protect this child's quality of life. It was a problem of warm and delicate understanding that could not be defined by the cold calculations of medicine alone.

Next, the Axial Balanced Turbo Field Echo sequence appeared on the screen. This sequence can be obtained quickly and shows the detailed internal structure of the heart. The unique trabeculation of the right ventricle was highlighted, and the wall thickness and muscle movement came into my eyes like a small waterfall.

"Does this show how the inside of the child is moving right now?" the mother asked as if she were talking to herself. "That's right. It shows the structural characteristics of the right ventricle, and you can see at a glance how stably the pump in charge of systemic circulation is working. It's important to check whether the wall thickness looks very thin, or whether the burden is concentrated in a specific area." I explained again. "These images help understand the current state and give us a direction on what kind of instructions are needed in the future."

At that moment, the child's small arm trembled slightly. The guardian's hand wrapped around that arm more firmly. The child tilted her head slightly and blinked slowly. With this small gesture, I felt that this work was not just a medical discussion, but a sincere story that could share the weight of life.

The next scene moved to Coronal and Sagittal images. These images, which show the relative positions of the aorta and pulmonary artery, provide clues about the direction of blood flow, the speed of the flow, and the possibility of blood vessel compression. As the lines on the screen connected, the child's body looked like a city. The blood vessels were roads, and the blood was cars. Some places were always crowded, while others were quiet like an off-peak hour. The order of this city was a safe balance that was protected by the parents' hands and the doctor's judgment.

"So can you also predict whether the child will be able to move in the future with these pictures?" the father asked, and I nodded. "Partially. The efficiency of blood flowing in the systemic circulation, the balance of oxygen supply, and the harmony of pulmonary blood flow can affect the amount of activity and the quality of sleep. However, this is a matter of probability, and it actually changes over time. Today's images tell the story of this moment, and tomorrow's images can unfold another possibility."

While we continued the conversation, I felt the air in the room change little by little. The tense air was lightly connected, slowly releasing as if taking a breath. The moment a smile was about to spread on the child's face, tears welled up in the mother's eyes, and the father's lips were tightly pursed. At this moment, all the words were no longer words of reason, but the language of the heart.

"At what point do we consider surgery?" the mother's question approached carefully. "The necessity and timing of surgery are determined by considering the child's heart function, the degree of tricuspid valve regurgitation, the heart's adaptability to systemic circulation, and the child's age and overall health status. We also compare the risk of surgery and the expected effect with the family's values and life goals. Today's images are just data that provide the starting point for that decision, and the final judgment is made by the family and the doctor together."

"Can our child's life get better?" the mother asked quietly. Her voice gradually lost its tremor, and instead, a light of determination seemed to shine. "There is a possibility. But it is just a 'possibility' and not a fixed path. What's important is to accurately understand the child's current condition and make a plan in a way that respects the quality of life the family wants. All the discussions we have are aimed at helping this child live a more comfortable, safer, and more loved life."

The hands of the guardians holding the child's hand clutched each other more firmly. The small hand moved slowly as if pouring strength into the back of the large hand, conveying warmth. The pain this small body was going through was not yet fully conveyed in words, but everyone in this room was already reading the shape of that pain little by little.

"Watching the images, we feel like we've become the main characters of the story, too," the father said quietly. "We are afraid that our choice will determine our child's tomorrow, but at the same time, we have hope that our child can grow up better."

I nodded. "That's right. Images speak in the language of science, but conversation is the language of life. This child's story is not a story created by the numbers on the screen or the lines in the images, but a living story that the family who loves this child and the medical staff create together. In our conversation, this child's possibilities are created, and this actually leads to a life."

The night deepened, and outside the window, the city lights scattered and then gathered again. The child's heart continued its regular beat, and the people in the room comforted the meaning of the silence by listening to each other's breathing sounds. Even in this silence, the words did not forget to flow. Although there were moments when medical terms flashed through my head, the bigger flow was the space of the heart.

"When will we see the next images?" the mother asked. Her voice was still calm, but her breathing was a little more stable now. "We will take them at the next visit, or earlier if necessary. We won't stop at looking at one picture, but we will watch the story that changes as time goes by. Each image is not a record that preserves the past, but a signpost that points the way forward."

At those words, the atmosphere in the room changed once again. Instead of the forced coolness that the word "signpost" gives, it came as a word that gave a warm sense of direction. This child's story has not ended yet, and this family's choice has not been completed yet. We read the signals in every moment and every image, and we confirmed the meaning of the signals with each other's smiles and gazes. When the room became quiet again, the child's eyes slowly swept across the ceiling of the room. The light reflected in her eyes was compassion that could not be expressed in words. The vitality that this small being showed from under her skin contrasted with the cold machine sounds in this room, creating greater warmth.

Finally, I imagined the process of this small story turning a page and becoming deeper. The images continued to change, the data was added, and the doctor and the family held each other's hands and drew the path forward. A new sequence will appear every time, and a different interpretation will be possible every time, but one thing is clear. This child's life is not defined only by the scientific facts presented by the images. It is understood more deeply and respected more in the conversation we share with each other's words and gazes. That was the small victory of this room. The images tell the truth in a cold and accurate language, but the conversation takes care of this truth with a warm and delicate touch. So this story was not just a record of a disease, but a living story created by the courage of a family and the responsibility of a doctor.

When the next chapter begins, another image may change this child's life. But the conversation and empathy we shared in this room today, and the promise to watch over each other and walk together, will remain as the most precious pillar that this child's heart must protect. And this story does not end. The images continue to evolve, and our conversation continues. Hoping that the story of this small body will become more abundant, I end today's conversation. I will not say the child's name here, but this story will continue until all the voices and hearts in this room make the child's name into a song and sing it. Until the next image begins, we will hold each other's hands a little tighter and become the guides to this story that makes the heartbeat of the small heart sound loud. On this path, emotion became deeper, empathy became wider, and love became firmer. This was one page of Chapter 3 of the Clinical Journal, "The Story in the Images."

Chapter 4. Conversation with the Parents

Treatment for CC-TGA (Congenitally Corrected Transposition of the Great Arteries) is largely divided into management for asymptomatic/mild cases and intervention when symptoms appear. Asymptomatic children require continuous follow-up observation. Conversely, if symptoms appear, active management is needed to respond to complications such as tricuspid valve regurgitation, heart failure, or arrhythmia. However, ultimately, surgical correction such as the "double-switch surgery," which converts the anatomical left ventricle to the systemic circulation, or the Rastelli surgery, may be considered.

Today, I thought about this child's about what would be the best path for this child. Double-switch surgery is a powerful option that can fundamentally change this child's future, but the surgery itself entails a great burden and risk. More important than the success of the surgery is the stability and quality of life that the child can live without trauma.

"Doctor, what is the best choice for our child?" The mother's voice was so quiet that it trembled precariously like a candle flame. The question was simple, but the weight it contained was immense. No matter what answer I gave, that answer would be the starting point for determining a child's life and a family's future. I took a moment to catch my breath and opened my mouth calmly. "First, we will continue to closely observe the child's condition. It is a great relief that the child is not showing any serious symptoms right now. However, over time, the anatomical right ventricle may have a hard time withstanding the burden of systemic circulation. It's like a marathon runner running a short-distance race for the rest of their life."

The father nodded at my words. His face was filled with deep worry, along with his efforts to understand. "So, even if the heart function is okay right now... it could be a problem later?" "Yes, that's right. And that problem can appear as tricuspid valve regurgitation, heart failure, or arrhythmia. If such symptoms appear, we will start drug treatment. But that is only a palliative treatment that relieves symptoms. To solve the fundamental problem, we need to consider 'anatomical correction.' That is the double-switch surgery."

The mother's hands trembled. "Surgery...? My child is still too young..." Her fear was fully felt. I was the same. Opening a five-year-old child's chest and touching their heart was something I never got used to. But as a doctor, I had to consider this child's long-term life. "Yes, I know. That's why I wanted to have a full discussion with the parents today. Double-switch surgery is a complex and difficult surgery. It's a surgery that corrects the complex connections inside the heart. It's like putting two lost train lines back in their place. But the goal of this surgery is to help this child live a healthy and normal life like other children."

I put the child's MRI image on the monitor. On the screen, the child's heart was still beating actively. But I knew that a day would come when that active heartbeat would become too much. "As you can see in this image, the anatomical right ventricle is in charge of systemic circulation. If a long-term burden is placed on this part, the function can eventually decrease. Double-switch surgery changes this child's anatomical left ventricle to be in charge of systemic circulation. Then the burden on the heart is greatly reduced. It's like putting the original marathon runner back in their place."

The father asked, "What is the success rate of the surgery?" Without a moment's hesitation, I answered, "It's high. But that's not everything. The surgery may be successful, but the mental and physical trauma the child experiences during the process cannot be ignored. So I don't want to simply tell the parents, 'Surgery is the answer.' This child's life is not determined by a single surgery, but is completed with a long recovery and management after surgery, and the parents' love."

The mother quietly shed tears. "Did this happen to our child because of us...?" I shook my head firmly. "Absolutely not. The exact cause of CC-TGA has not yet been clearly identified. It can occur as a random error in the fetal heart development process, and some genetic and environmental factors have only been reported to be involved. It is not the parents' fault. Never blame yourselves." At my words, the mother wept silently. The father quietly put his arm around the mother's shoulder. Their sadness was fully conveyed to me as well. But at the bottom of that sadness, deep love and a sense of responsibility for the child were firmly in place. I saw that love and decided to respect their choice.

"For today, it would be good to finish here. It is important for the parents to have enough time to think. Let's meet again at the next consultation and talk. Whatever choice you make, our medical team will be with the child and the parents." The parents thanked me and left the hospital room. I sat in my chair and thought about them for a long time. There are many treatment paths. What choice will the parents make on that path that contains a child's life?

I have performed surgery on countless children. Some children were given a perfect life through surgery. Other children had to continue a difficult fight with complications for a long time, even after surgery. Surgery is not a magic wand that solves everything. It is just a job of opening a door for a new beginning. And a child who has passed through that door faces another difficulty. Some parents choose to delay surgery and opt for conservative treatment to avoid immediate danger. Other parents decide to take the risk and have surgery for the child's long-term life. There is no right answer. Every choice is meaningful and right in itself. I believed that this child's parents would also make the wisest and most courageous choice. Because I saw the tears and promises in their eyes. This story is not just a story of a doctor and a patient. It is a story about hope and despair, fear and courage, and above all, infinite love. I felt a deep sense of responsibility and reward in writing a page of that story with them.

At the next consultation, the parents came to me with a firm expression. "Doctor, we have decided to have the surgery." Their voices no longer trembled. Their eyes were shining with conviction, not sadness. I quietly nodded. "That is a wise choice. And a courageous choice. We will do our best to help the child. Don't forget that the child's life has not yet begun. This is where the real start is." I held their hands. Their hands were no longer cold or precarious. They were filled with hot love and unshakable faith. Holding their hands, I vowed once again to do my best for this small heart and for this child's brilliant future.

Chapter 5: The Path to Healing, The Weight of Choice

As a medical professional, my job isn't merely to convey medical knowledge. It's to become a companion walking a treacherous mountain path, helping to find the safest and most hopeful route among the countless forks in the road.

This is especially true with a young patient, where the path is directly tied to a child's future, demanding even greater caution. Today, I stood at the entrance of that very path with the family of a five-year-old girl. Her diagnosis: Congenitally Corrected Transposition of the Great Arteries (CC-TGA). A complicated and difficult name, the treatment path for this condition was also far from simple.

The treatment for CC-TGA largely branches into two routes.

The first is the path of "asymptomatic/mild symptom management." This route is chosen when the child shows no particular symptoms. Like carefully handling a cup with an invisible crack, we meticulously monitor the child's heart condition. Regular heart ultrasounds, MRI scans, and Holter monitoring are crucial to carefully observe any changes in cardiac function. While on this path, the top priority is to help the child grow healthily within a normal daily life. However, this path is not forever. The moment may come when that crack widens or shatters.

The second path is "intervention upon symptoms." If the child complains of shortness of breath, becomes easily tired, or if an arrhythmia is found on an electrocardiogram, we can no longer simply monitor. Aggressive management is needed to deal with complications such as tricuspid regurgitation or heart failure. We must start medication and sometimes consider procedures like the insertion of a permanent pacemaker. This path can feel like a continuous series of emergencies, finding solutions for each problem as it arises.

I explained these two paths to the girl's parents step by step. The father listened intently with a grim expression, while the mother held the child's small hand tightly, her eyes filled with anxiety.

"Doctor, does it eventually mean surgery is the only option?"

The mother's voice trembled. Her question was not just a simple inquiry. It was a desperate plea, like entrusting all of this child's future into my hands. I paused for a moment and met their gaze.

"Ultimately, we may consider anatomical correction. This would be a surgical correction like the 'double-switch' or 'Rastelli' procedures. This surgery is like untangling a complex knot and reweaving it. We would switch the heart to allow the anatomical left ventricle to handle systemic circulation. This would significantly reduce the long-term strain on the heart, increasing the chances of the child living a healthy life."

To explain the double-switch procedure, I moved my hands. My right hand was the left ventricle, my left hand the right. I showed them the motion of swapping these two hands, metaphorically explaining the complex and delicate process. The confusion and fear on their faces were palpable.

"It's true that the surgery itself comes with significant risks and burdens. However, it is also the most powerful option that can fundamentally change your child's future."

I spoke honestly. As a doctor, I must transparently inform them of all possibilities and risks. I didn't want to give them false hope. But at the same time, I didn't want them to lose hope entirely. The words of a medical professional always carry this dual weight.

"There is something more important than the success of the surgery."

I looked into their eyes and continued.

"That is the stability and quality of life for your child to live without trauma."

The mother's eyes wavered. "Trauma...?"

"Yes. The surgery can be successful. But the mental and physical pain the child goes through during the process doesn't easily disappear. Long-term recovery and management are needed even after the surgery. We aren't just fixing the child's heart; we are treating their entire life. I hope that you, as parents, will look at this child's life and your family's life as a whole and make the best choice."

Their silence was long. In that silence, I saw countless questions.

'Is our choice truly the right one?', 'Will the child suffer?', 'What if the surgery goes wrong?' Their eyes were deep and dark, like looking into the abyss.

I no longer offer any medical advice. I simply wanted to hold their hands and share that weight with them.

"This child has not yet seen much of the world. The cherry blossoms scattering, the first snowfall piling up, playing happily with friends, or falling asleep, embraced by their parents' warm arms. This child's life is just beginning. I hope that this beginning can be the most beautiful and safest path, and I ask that you walk it with us."

At my words, the parents looked up.

There were still tears in their eyes, but they were no longer sighs. They looked like a promise for the time ahead. They understood the risks of the surgery, but at the same time, they were beginning to envision a bigger picture for their child's future.

The path to healing doesn't end with a single choice. It is an accumulation of countless moments of choice that completes a single journey. And as a companion on this journey, I will hold their hands and walk with them.

With this small girl's heart, and with the boundless love that surrounds it.

Chapter 6: The Mindset Before Surgery

Surgery always comes with fear. Even if I were to spend decades on the operating table, each surgery is a moment of facing a new human story. Today, I look at the scars etched on my hands and think about whose lives these scars have illuminated.

Surgery is my profession, but for me, it signifies more than a mere skill. It is the deepest sense of responsibility for a human life and a promise filled with trust.

Outside the window, darkness was falling. The hospital window reflected my tired face and the faint hospital lights. The traces of sleepless nights of 고민 had cast shadows under my eyes.

I quietly spread my palms. Faint white lines settled between the knuckles and the creases of my palms. My scars. Traces of being grazed by a scalpel, pricked by a suture, and cut by sharp surgical tools. These scars are not just wounds.

They are records of countless nights I've been through and the stories of countless lives. One scar was from repairing a child's heart valve, and another was from reopening a blocked blood vessel. In each of these scars, the patient's name, their laughter, and the tears of their watching families are engraved.

Today, based on my understanding of this child's heart, I must find the best surgical strategy. This small girl's heart, that complicated CC-TGA structure, once again posed a fundamental question to me.

"How can we preserve the functional value created by the ventricular mismatch?"

How could we make this peculiar heart, which was anatomically wrong but miraculously maintained circulation functionally, as close to normal as possible most safely and effectively?

I continued to debate with my colleagues late into the night. The radiologist once again displayed the MRI images. On the screen, the child's heart revealed a complex labyrinth, like a living architectural structure.

"Is it possible to correct the left ventricle to handle systemic circulation?" I asked.

This was the core of the double-switch procedure. The anatomical left ventricle is optimized to handle systemic circulation. But in this child, the left ventricle was sending blood to the pulmonary artery. To untangle this twisted path, we had to go beyond simply changing the path; we had to rearrange the internal walls and valves of the heart.

My colleagues offered their own opinions. One cited the latest paper on surgical success rates and was optimistic, while another cautiously warned about potential post-surgical complications. The discussion sometimes flowed as quietly and seriously as a concert. Everyone looked at the monitor, carefully bringing out their knowledge and experience. And at times, it became passionate. They refuted each other's opinions, proposed new possibilities, and raised their voices to find the perfect solution.

"What about the Rastelli procedure? If we patch the VSD and connect the right ventricle and the pulmonary artery..."

"No, that would put more long-term strain on the right ventricle. It will eventually lead to heart failure."

"But the double-switch procedure is too technically complex and could cause more trauma to the child."

"But if it succeeds, it can fundamentally change the child's quality of life. We have to think about the long-term prognosis."

Each logic was tightly opposed. But no one blamed each other.

Everyone's goal was just one: to find the best path for this child. As the night deepened, our voices grew quieter, and instead, a deep sense of responsibility passed between our eyes.

Ultimately, it is the responsibility to change the small ripples of a child's life into a bigger ocean. We all knew that a single surgery couldn't solve everything.

But we also knew that that single surgery could determine the course of this child's entire life. I stood up from my chair and walked to the window for a moment. The city lights outside the window twinkled like stars in the night sky. Was one of those many lights this child's light? Countless lives must be writing their own stories under those lights. And we were deliberating this late into the night to change one page of that story.

"The conclusion is that we should make the double-switch procedure our primary strategy."

I said.

Everyone nodded quietly. The double-switch procedure certainly carried a high risk. But in the long run, it was the most powerful option that could give the child the most stable life. We were fully aware of the weight of that choice. That choice was not merely a technical decision. It was a decision for courage and hope.

When the meeting ended, my colleagues left one by one. I remained alone and looked at the video of the child's heart on the monitor again. The small heart was beating strongly. To ensure that this small heart could enjoy all the beauty in the world, I would walk into the operating room tomorrow morning with the clearest mind and the firmest hands. As the scars on my hands told me, my hands would be willingly wounded for this child's life.

The night before the surgery was, as always, quiet. I didn't go home and lie on a hospital bed. Sleep wouldn't come. Only the image of the child's heart kept circling in my mind. I remember the warm feeling I felt when I held the parents' hands. Their trust and hope gave me great strength. Tomorrow morning, I have to repay that trust.

The lights outside the window went out one by one. The blue of dawn enveloped the hospital corridor. I got up from the bed and spread my hands again. The scars were even clearer. These scars are my testament. The traces of my facing countless lives and sharing their pain and joy with them.

I quietly took out and put on my surgical gown. The cold touch of the surgical gown cleared my mind. Their words that this child's life has not yet begun. Yes, this is the real start. We will give this child a new beginning. With the parents, and with all my experience and knowledge.

The corridor leading to the operating room was long and dark. But I was not afraid. My hands held all the experiences of the past years and the stories of patients. And in front of me, this child's brilliant future was waiting. I moved forward step by step towards that future. I will never forget that more important than the success of the surgery is the stability and quality of life for the child to live without trauma.

Chapter 7: Preparation and Waiting for Surgery

Preparing for surgery is a long process of waiting. Beside the quiet operating table in the hospital, a question mark always hangs in the air. This child's family rejoices at every small change and trembles at every minor abnormality.

I held their hands and left them with the promise, "We will walk this path together."

The atmosphere on the day before the surgery was quiet. The child's heart sounds were still calm, and our minds as doctors were quietly taking a breath.

Time in a hospital flows strangely. The busy movements of the medical staff and the ticking of clock hands, and the quiet sitting of patients and guardians. In that gap, time can stretch or fly by. Since the surgery date was set, every day must have felt like a rollercoaster for this little girl's family. They were happy when the child ate a little better in the morning and trembled with anxiety when the fever rose even slightly at night. All their emotions were tied to every small gesture of the child.

I visited the room frequently to check on the child's condition. The child smiled innocently, and I felt relieved seeing that smile.

The child's parents asked me again and again.

"Doctor, are the child's heart sounds okay today?" "She looks better than yesterday, don't I?"

Their eyes held a mix of hope and anxiety.

I held their hands and repeated the promise, "We will walk this path together."

I hoped that the promise would give them at least some comfort.

On the day before the surgery, the air in the hospital became even heavier. The corridor was quiet, and everyone was holding their breath. The medical staff made their final preparations in their respective places. The radiologist reviewed the final MRI images, and the anesthetist calculated the anesthetic dose according to the child's body weight. I simulated the surgical strategy one more time. The double-switch procedure is a complex process of correcting the anatomically reversed heart structure. The task was to relieve the burden on the anatomical right ventricle, which was handling systemic circulation, and to restore the anatomical left ventricle to its original place. On one small heart, the knowledge and experience of countless medical professionals and the future of a single child were riding on it.

I checked the surgical tools and equipment until late at night. The scalpel shone sharply, and the sutures were finely wound. Everything was perfectly prepared. But a question mark still floated in a corner of my mind. What if an unexpected variable occurs within this complex heart? How would a small mistake affect the child's life? The weight of responsibility pressed on my shoulders.

The night before the surgery, I visited the child's room again. The child was already asleep. The small body was quietly breathing on the bed. The child's heart sounds were still calm, and that sound made my mind take a calm breath. I held the sleeping child's hand. The small palm was warm. It felt as if the warmth of the parents and my cold hand met and became one.

The child's heartbeat seemed to whisper to me.

"Don't be afraid, Doctor. I will be okay. Because my parents and you are with me."

I quietly sat by the child's bed and closed my eyes for a moment.

Surgery is my profession, but for me, it signifies more than a mere skill. It is the deepest sense of responsibility for a human life and a promise filled with trust. Tomorrow morning, I will open this child's heart and enter that complex labyrinth. But I am not alone. The trust and love of the child's parents and all my colleagues will be with me. We all want to help this small heart regain a healthy beat and feel more of the beauty of the world.

The blue of dawn seeped through the hospital window. I quietly left the child's room. Tomorrow morning, I will give this child a new beginning. With the parents, and with all my experience and knowledge. Their words that this child's life has not yet begun. Yes, this is the real start. We will give this child a new beginning. With the parents, and with all my experience and knowledge.

The corridor leading to the operating room was long and dark. But I was not afraid. My hands held all the experiences of the past years and the stories of patients. And in front of me, this child's brilliant future was waiting. I moved forward step by step towards that future. I will never forget that more important than the success of the surgery is the stability and quality of life for the child to live without trauma.

Chapter 8: The Surgery and Life Afterward

Surgery is like a great masterpiece. It's a process of aligning multiple layers of needs and possibilities in a single direction. The same was true for this child. The options of the double-switch procedure or the Rastelli procedure each have their pros and cons. After the surgery is over, the child's body must continue to breathe as a small life. We look forward to the day when this child can smile with their family again through the daily recovery process.

The operating room felt like a space where time had stopped. The scalpel reflected a cold light, and the countless sounds of machines echoed rhythmically. My eyes were fixed only on the child's heart.

The anatomically reversed position of the ventricles, the twisted blood vessels... I recalled the simulation from last night one more time in my mind and cautiously moved the scalpel. Like untangling a tangled thread, we meticulously corrected the complex connections within the heart one by one.

The surgery was a precise operation that did not allow for a single mistake. My hands had been trained for a long time, but the tension of handling a life always made my heart race.

How much time had passed? The tension in the operating room finally turned into a hopeful relief. The child's heart was now beating rhythmically, with the anatomical left ventricle handling systemic circulation. As if a clock that had been stopped for a long time had started moving again, we were witnessing the start of a new life. The surgery was successful. But my mind was not yet at ease. The surgery was over, but the real battle was just beginning. The fight against potential post-operative complications and helping the child to recover completely.

The child's form, transferred to the recovery room, was still small and frail. A pale face, a small body connected to countless tubes. But I saw it. The pulse in the wrist was gradually getting stronger.

Each of those small pulses was saying to me.

"I'm here. I'm okay." The parents shed tears while holding the child's hand.

Those tears were no longer tears of fear. They were tears of relief, gratitude, and new hope.

I quietly left the recovery room. My hands still remembered the cold touch of the scalpel. But now, instead of that coldness, I felt the warmth I had felt from the child's small palm. Looking at these hands, I imagine what story this child will create as they grow up. Maybe playing with friends at school, playing soccer, or even the moment of first love. Medicine cannot predict all those moments, but the desire to protect this child's life remains unchanged.

The scars on my hands tell me today. You saved a life with surgery, but that life was given a new life through your hands. This child's story is just beginning. Countless moments will fill this child's life. And I have the privilege of watching this child's life story from the very front. So that this child can grow up healthy and face the world without any trauma. My mind quietly takes a breath today, preparing to embark on that great journey together. The surgery is over, but our companionship will continue.

Chapter 9: The Hospital Returns to Routine

When a few weeks have passed after the surgery, what remains is the return to the hospital's routine. A long path of consultations, examinations, and rehabilitation lies ahead. But I am now more familiar with this child's face. Each time we meet, the child's eyes shine with a small determination. That light is the power that makes us move forward. And I see the same power in the parents' faces. Amidst the fear, a strong current of belief and love for the child flows.

The hospital's routine surprisingly returns to its place quickly. The operating room is filled with other patients again, and the recovery room is full of new hopes and anxieties. But for me, this child's recovery process is still the most important story. Every morning during rounds, I first looked for this child's room. The small body that was first lying motionless is now moving a little, and the eyes that weakly opened are now looking straight at me.

Those eyes held countless questions.

'Doctor, am I okay now?', 'When can I go home?'

The child gradually adapted to the hospital routine. She practiced walking with the physical therapist and started eating the food recommended by the nutritionist, little by little. Sometimes she cried when it was difficult, but she soon wiped away her tears with her small hand and got up again. Every one of those small gestures moved me. The child was showing a strong will for life, even amid fear.

The parents' appearance also changed. The anxiety and despair they had when they first came to the hospital had now turned into hope and belief.

They held the child's hand and talked quietly.

"Just hold on a little longer, sweetie. You'll be able to go home soon and watch the soccer daddy likes and eat the delicious food mommy makes."

Their voices no longer trembled.

Amidst the fear, a strong current of belief and love for the child flowed. I realize every day how great that power is.

Life in a hospital may seem far removed from the ordinary, but in reality, it is the most fierce field of life. Here, every moment, life and death, despair and hope intersect. And in that, we learn the most essential values of life. I see something beyond the limits of medicine through this child and her family. It is the strong human spirit and infinite love.

A few days later, the child finally started preparing for discharge. For the last time, I looked at the small scar left on her chest. It was a trace of the surgery, but at the same time, it was proof that she had started a new life. What meaning will this scar leave in the child's life? Maybe the child will look at this scar and remember her strength. The moment she courageously answered the big question life had thrown at her.

I held the child's hand and said.

"This scar shows your courage. Don't forget. You are a very strong child."

The child smiled brightly and nodded.

And she ran to her parents and was embraced by them. The child in their arms was no longer a sick patient. She was a lovely daughter, ready to return to her normal daily life.

I watched their backs from the hospital window. The child was walking strongly, holding her parents' hands. There would be countless examinations and rehabilitation sessions left, but they were no longer afraid. Their eyes shone with a small determination. That light is the power that makes us move forward.

My job as a doctor is over. Now, this child's life rests in her parents' hands. But I know. Their love and belief will make this child's heart beat forever. And from a distance, I will always support their journey.

Chapter 10: Light and Shadow in Prognosis

The prognosis of CC-TGA varies from case to case. Simply following up well does not solve all problems. Because the anatomical right ventricle handles systemic circulation, there is a risk of heart failure, tricuspid regurgitation, and arrhythmia in the long term. However, when the left ventricle is switched to handle systemic circulation through surgery, the survival rate can improve. This child's future is also on that path of possibility.

A few weeks after the surgery, the sense of responsibility for this child did not end in my heart. The surgery was successful, but I still couldn't let my guard down. The prognosis of CC-TGA is not simple. It's like a path where light and shadow coexist. Since the left ventricle now handles systemic circulation through surgery, this is the 'light.' The survival rate has improved, and the possibility of the child's quality of life increasing has opened up. But behind that light, a 'shadow' still looms. Complications that can arise as the anatomical right ventricle handles pulmonary circulation, and the risk of arrhythmia or heart failure can appear at any time after the surgery. I must keep all these possibilities in mind and watch the child's growth process.

I think of this child again today. The child's face, who comes to the hospital regularly, was no longer pale. A rosy vitality was on her cheeks, and her eyes sparkled with the curiosity to hold everything in the world.

Every time we met, the child would chatter away.

"Doctor, I can play soccer now!" "Doctor, I eat well now!"

Every small word she said made my heart warm.

The child's eyes shone with a small determination that was different from before the surgery. A strong will towards life, to move forward. That light is the power that makes all medical staff, including me, move forward. And I saw the same power in the parents' faces. The fear they had when they first met me had disappeared, and now, a strong current of belief and love for the child was flowing. They were thankful for every change in the child and living while discovering small miracles.

Medicine is ultimately about comforting people's hearts. I fixed this child's heart through surgery, but what is truly important is life afterward. It is not enough for the child's heart to beat normally. The child must be able to smile happily, love, dream, and move towards that dream. The touch of the child's small heart I touched is still on my fingertips. It was not the touch of cold, hard medical technology, but the touch of hot vitality and warm hope. Through that touch, I realize that medicine is something that conveys a certain warmth that flows beyond the boundaries of blood, flesh, and bone. When that warmth remains on our fingertips, this world becomes a slightly better place to live.

I sometimes imagine what this child will look like in 10 or 20 years. Maybe she will become a doctor and come to find me, or maybe she will become an artist and draw beautiful pictures. Whatever life she lives, I hope this child is healthy and happy. The scars left on my hands are an eternal promise with this child. A promise for the success of life, beyond the success of surgery.

This child's story is not over yet. The regular check-ups will continue every year, and the long years of follow-up. It is another long story that the child, the family, and I will create together. This story proves that a small heart holds a big story. And I hope that our families and doctors who listen to this story will also find small miracles in each other's lives. I look at the scars etched on my hands today. And I think about how many more lives these scars can touch in the future. My resolve will continue without wavering.

Chapter 11: A Message of Hope

As I conclude today's record, I leave one thing for the readers. Congenital heart diseases like CC-TGA are rare and complex. But even in such complexity, humans find the strength to live, listen to each other's stories, and respect small achievements as great gifts. This clinical journal, like a novel, is ultimately a small record to comfort a family's life and help a child dream of a brighter tomorrow.

The reason for leaving this record is simple. This child's story is not just a story about one doctor and one patient. This child's story is the story of all children on this earth and everyone who loves and protects them. This child has proved that life sometimes throws unexpected hardships at us, but we can find hope in those hardships and become a source of strength for one another.

I hope that all who read my writing will find small miracles in their lives and have a heart that is grateful for even small achievements. And I hope that you can extend a warm hand that can be a source of strength for someone.

Epilogue: From Patient to Colleague, and to Family

The hospital always carries the same scents. The smell of disinfectant, the smell of cold metal, and sometimes, the smell of a child's small sweat. But in between those smells, we find each other's warmth. This child's story is not over yet. I will continue to watch this child's journey of growth, rehabilitation, and possibility. And I hope that a ray of warm light will shine in the hearts of you, the readers of this story.

A few years later, I met the family again who came to the hospital for the child's regular check-up. The child had grown much taller, and a healthy smile bloomed on her face. She was no longer a small patient lying on a hospital bed. She was a normal child who played soccer and joked around with her friends.

I sat with her parents and listened to the story of her growth.

"Doctor, she's really healthy now. She plays better than her friends."

A calm smile spread across the parents' faces.

That smile seemed to heal all the pain and anxiety of the past.

The child saw me and greeted me warmly.

"Doctor, I'm going to be a doctor now!"

I was surprised but happy at the child's words.

"Why do you want to be a doctor?"

When I asked, the child smiled brightly and said.

"I want to fix sick children's hearts like you did, Doctor. And I want to help those children live happily without being sick like me."

At that moment, I realized that it was not I who fixed this child's heart, but this child who fixed my heart. Doctors treat patients, but patients teach doctors the meaning and preciousness of life. This child was not just a patient to me. She was now a colleague and like a family member walking the path of life with me.

The sunlight poured into the hospital window. A small flower was blooming in a pot on the windowsill. That flower was just like this child's life. A beautiful flower that bloomed after overcoming hardships and adversities.

I held this child's hand. It was no longer a small and frail hand. It was a hand filled with a strong will for the future. I will watch this child's journey of growth, rehabilitation, and possibility. This child's story is not over yet, and it will continue.

And I hope that a ray of warm light will shine in the hearts of you, the readers of this story. I dream of a warm world where people do not lose small hope amid life's hardships and listen to each other's stories. I will never forget that all this began from a single child's small heart.

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