For what purpose (4)
“Patient. What is your name?”
“It’s Randy.”
“What is the name of your disease?”
“It’s pancreatic cancer.”
After finishing the timeout, Jose looked at Smith and Smith nodded.
As the surgeons settled in, the anesthesiologist injected an anesthetic solution into the vein to check the patient’s vitals.
The patient’s stiff body gradually relaxed.
“Mr. Choi.”
“yes!”
Suuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu. Suuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu.
Choi Ki-seok disinfected the patient’s abdomen and covered it with a cloth.
“Meth.”
Smith held a scalpel and cut into the patient’s abdomen.
As the fascia and peritoneum split in order, the organs were revealed at a glance.
According to the examination, cancer was present in the head of the pancreas.
The size of cancer tissue is 5cm.
It is at a level that can be clearly seen with the naked eye without wearing a loupe (optical glasses).
“The lymph node metastasis is as expected, but there is pus in the tail of the pancreas.”
“What should I do? Don’t answer Todd.”
Smith’s eyes were fixed on Ethan.
“I think we can cut out the area around the abscess and then suction and disinfect it.”
“That’s correct. You seem to have come to your senses now.”
“Oh yes. I will do my best.”
Ethan answered bravely.
He regained his confidence after overcoming the invisible hand.
Choi Ki-seok secretly smiled at that sight.
If he can be this confident in front of Smith, he will be able to perform better in other surgeries.
‘Anyway, the problem is me.’
I bit my lip inside the mask.
Unlike usual, my goal today is to get scolded by Smith. To get debuffed, you had to make a clearly visible mistake, and that wasn’t easy.
First of all, today, unlike other times, was the third assistant.
There wasn’t much treatment needed during surgery.
More importantly, mistakes made during surgery are linked to the patient’s life.
In other words, getting scolded by Smith was no different from trying to play pranks with the patient’s life as collateral.
“Meth.”
Smith took a scalpel and carefully cut out the abscess.
Thick fluids flowing down.
First assistant Todd suctioned the abscess with a suction device and thoroughly washed the surrounding area with saline solution.
Afterwards, Ethan began disinfecting the area.
“Now let’s get to the main treatment.”
Tdu-duk-duk.
Smith cracked his neck and grabbed the scalpel.
The full-scale excision work began.
Smith broadly resected the head of the pancreas where the cancer was located.
Steady hand movements and precise cutting area.
Smith’s restraint was robotic.
Although it was possible to damage blood vessels or nerves during the resection, there was not a single mistake.
Gastrointestinal Surgery, Colorectal Surgery, Hepatobiliary and Pancreatic Surgery.
The monster who mastered three fields of general surgery was, as expected, different in some ways.
Empty!
A pancreas with cancerous tissue fell onto the bench.
“Biopsy.”
“yes.”
Choi Ki-seok took the cut part separately and handed it over to the circulating nurse.
“Next are the lymph nodes. Scrapers.”
Smith took a scraper and began scraping off the lymph nodes attached to the body and tail of the pancreas.
With Todd’s assists added, the lymph node removal accelerated.
‘It won’t work either.’
Choi Ki-seok gave up his intention to assist Todd and Ethan.
My conscience did not allow me to force myself to make a mistake during surgery.
We will find a way to scold the patient outside of the operating room without causing any harm to the patient.
The resection continued.
Smith cut out the duodenal common bile duct and part of the gallbladder that adjoins the pancreas.
Ki-Seok Choi assisted and recorded a video of Smith’s Whipple surgery.
I felt sorry for Rahul, who passed the scrub.
I can’t believe I missed the opportunity to see Smith’s Whipple surgery in person…
After three hours, all necessary resections were completed. However, the challenges of pancreatic cancer surgery still remain.
How well can you connect the various organs that have been cut out?
This determines the success of the surgery.
“Are taxes difficult?”
Smith stared at Jose with narrowed eyes.
“Oh… no.”
“No, it’s not true. You’ve been secretly yawning and squirming and causing trouble since a while ago. Are you feeling lax about not taking care of it yourself?”
“….”
“With such a rotten mind, even if you wake up from death, you won’t be able to use it! What kind of surgery would you do if you couldn’t even assist properly!”
“I… I’m sorry. I’ll do my best.”
Jose bowed his head.
“If your family member is having surgery and the staff is yawning and shaking their legs in the operating room, it must be a great feeling, right?”
Despite Jose’s apology, Smith continued his vitriol.
It’s enough to send shivers down the spine of even people who aren’t directly involved in the vitriol.
“….”
“….”
Smith, who had finished his vitriol, and Choi Ki-seok’s eyes met.
With the tension flowing, Smith spoke first.
“Mr. Choi.”
“yes!”
“You’re doing great. Just keep doing it.”
Smith focused on the surgery and carefully watched the staff’s movements.
Because I found out that the carelessness of the staff surprisingly played a large role in problems that occurred during surgery.
According to what he has observed, Choi Ki-seok has provided textbook assistance.
He always maintained a perfect posture and his eyes were alive.
This means not thinking about other things during surgery.
In addition to his basic attitude, he was also excellent at helping other staff members. Because he was a third assistant, the work he did was not complicated or extensive, but he handled the work within his scope perfectly.
‘But I still have to scold what needs to be scolded.’
Smith suppressed the fire in his heart.
Aside from this surgery, there was something that would sting Choi Ki-seok.
“The suturing technique starts now. Everyone, keep your wits about you! Especially Jose!”
“yes!”
“All right.”
The surgery resumed with the staff’s response.
“2-0 Nylon.”
Geek.
Smith tightened the suture needle with a needle holder and sewed up the stomach and jejunum.
Like the excision, the suturing was flawless.
Choi Ki-seok felt reassured and comfortable, as if Song Myeong-jin had gone into surgery.
Certainly, skilled sergeants had the power to make other staff members want to lean on them and look forward to them.
“Methylene.”
At Smith’s cries, Ethan poured a blue solution onto the surgical site.
This was a procedure to check for leaks in the sutures. Fortunately, there were no problems.
Subsequent anastomosis of the duodenum and jejunum.
“Professor! There is severe bleeding in the SMA (superior mesenteric artery).”
Blood began to pour from the passage leading from the duodenum to the jejunum.
Cheeeeeeeek.
Choi Ki-seok quickly started suctioning, but more blood was flowing out than being sucked in. I had no choice but to hold the suction device in both hands and go for suction.
The blood pack shrunk due to sudden bleeding.
“Taxation. Blood pack replacement.”
“yes!”
“Has the bleeding been stopped yet?”
“Yes. I will use the boby (electric cautery).”
While Choi Ki-seok sucked the blood, Ethan found the bleeding blood vessel and cut it with an electric cautery.
White smoke rose into the air along with the smell of burning.
Even with emergency treatment, the bleeding did not stop. The wrinkles on Smith’s forehead gradually increased.
“Caisson (hemostatic) intravenously.”
“All right.”
Jose, who replaced Blood Pack, took additional measures.
After struggling for about 10 minutes, I managed to stop the bleeding. The staff’s bodies were already drenched in sweat.
“I almost got in big trouble.”
Smith sighed in relief.
If the bleeding had not been stopped, the surgery would have ended in table death.
The anastomosis of the duodenum and jejunum was completed, and the anastomosis of the duodenum and pancreas began.
Although Smith performed a clean anastomosis, the pancreatic fluid prevented the two organs from joining together properly.
Thanks to this, the surgery time took longer than expected.
“Finally, check the anastomosis site one more time.”
At Smith’s direction, Ethan performed a leak test at all anastomosis sites.
Results are good.
“There is no such thing as war.”
Smith looked at the wall clock.
Eight hours have already passed since the surgery. Due to unexpected bleeding and difficulties with the duodeno-pancreatic anastomosis, the completion time of the surgery took longer than expected.
But it is that moment.
Jiyiing.
A phone call came through Rosette.
“This is D Rosette.”
[….]
“Yes, I understand.”
Jose hung up the phone and returned to his seat.
“Head Chief. They say they are currently operating on a patient with an abdominal gunshot wound at A Rosette. But the bleeding won’t stop and they say they can’t remove the bullet….” “Are you saying you
need me?”
“I think so.”
“Head Chief, go to the other rosette and I will close the abdomen.”
Smith nodded at Ethan’s words.
“Then I’ll ask you to do the work later. Todd, follow me.”
With the departure of Smith and Todd, Ethan took over as the executioner and Ki-Seok Choi took over as first assistant.
“Whew… I think I’m going to buy something now. Don’t you, Mr. Choi?”
“Yes. I feel like my breathing has cleared up. I think I understand why other staff members are reluctant to assist the head chief.”
“Still, there’s a lot to learn.”
Ethan paused before continuing.
“Today’s surgery alone was amazing. It is rare for a surgeon to be able to complete a Whipple surgery so cleanly.”
“I admit that too.”
Choi Ki-seok decided to practice Whipple surgery in the training room.
I was curious to see how far I would be able to perform Whipple surgery with my current skills. If you try the surgery yourself, you will be able to clearly see the gap between yourself and Smith.
Gigigigigeek.
Ethan tightened the sutures with the needle holder and closed the abdomen.
The finishing work went smoothly.
“I think the surgery was completed safely. Shall we have a cup of coffee?”
“I like it.”
Choi Ki-seok nodded at Ethan’s suggestion.
“Jose, don’t be so upset. You know the Head Chief is always strict.”
“….”
“And since I continued to do well after getting scolded, it’s okay. Move me to the patient’s room and come down to the first floor. Okay?”
“yes.”
Just as Jose was about to push out of bed, the anesthesiologist announced the sad news.
“The patient’s breathing is rapidly dropping. PaO2 (partial pressure of arterial oxygen) and FiO2 (fraction of inspired oxygen) are below 250!”
“What is it? The surgery went well.”
Ethan looked down at the patient with a puzzled expression.
After the anesthesiologist’s report, the patient’s condition was rapidly deteriorating.
His face and lips turned blue, and his body began to shake slightly.
‘shit!’
Choi Ki-seok used the Eye of Hippocrates on the patient and frowned.
The diagnosis is ARDS (Acute Respiratory Distress Syndrome).
“Doctor, please give me the laryngoscope. The tube is 8.0 mm.”
“Yes? Oh yes. Here.”
Choi Ki-seok received a laryngoscope from a sterilizing nurse and carefully pushed it in until the patient’s vocal cords were visible. And later, the tube he received was pushed into the patient’s airway.
Lightning endotracheal intubation!
“Anesthetist. Please raise the arterial oxygen saturation to over 90 percent and
set the positive end-expiratory pressure to 0.5 T.O (oxygen transport) to 600.”
“All right.”
Ethan and Jose looked surprised at Choi Ki-seok’s instructions.
“Mi… Mr. Choi. What happened?”
“After listening to the story, I suspected acute respiratory distress syndrome. So I put him on mechanical ventilation.”
“So how did you know all that?”
“Didn’t I tell you? I was majoring in thoracic surgery when I was in Korea. I worked there for over three months.”
“Ah…”
“I said something was different.”
The two people belatedly understood.
“But the surgery was completed successfully. Why on earth am I getting acute respiratory distress syndrome?”
“Some of the causes of acute respiratory distress syndrome include acute pancreatitis and massive blood transfusion. Both have systemic effects and can affect the lungs.”
Ki-seok Choi finished his explanation and looked at the patient monitoring device.
Even though he was on mechanical ventilation, the patient’s breathing was still unstable.
‘What? It’s not over yet?’
