Mt. Cheopcheop (5)
.
Staff members lined up for Moyamoya disease surgery.
Before the full-scale surgery, Lucas personally gave a final briefing.
“As everyone knows, today’s surgery is not easy. This is because pediatric cerebrovascular surgery must be performed without blood transfusion. However, we have worked together steadily and achieved satisfactory results.”
“….”
“I hope you do your best so that the sweat you have shed so far is not in vain.”
“yes!”
Lucas continued the briefing.
Today’s moyamoya disease surgery is performed using complex vascular anastomosis.
In children, indirect vascular anastomosis is mainly performed, but recent research results show that complex vascular anastomosis has the best outcome.
Buck. Buck. Buck. Buck.
After the briefing, scrubbing began.
Choi Ki-seok rubbed his arm with a brush and reflected on the surgical process.
When I saw that one side of my chest was itching, I felt like I was going to activate my powers (absorbing the staff’s abilities in the surgery video).
Staff and patients entered the rosette at the same time.
While the anesthesiologist administered general anesthesia, the staff each went to work.
“I will prepare the Cell Saber.”
Ki-seok Choi got busy after reporting.
A cell saver is a device that cleans the blood aspirated during surgery and returns it to the patient, which is essential for blood-free surgery.
After the hectic preparations, the staff stood in their respective positions.
“From now on, we will begin complex vascular anastomosis for moyamoya disease surgery.”
At Lucas’ nod, Choi Ki-seok disinfected Vera’s cleaned head and covered it with a cloth.
“Meth.”
Lucas received a scalpel from the sterilizing nurse and began cutting the skin.
Even the incision was made carefully, as not even a single drop of blood was regrettable.
Druddudduddduk.
First assistant Cindy drilled a hole in Vera’s skull.
Perhaps thanks to Painkiller, there seemed to be no problem with his hand movements.
The same treatment should continue until the surgery is over… When
the skull was exposed, a picture of the head was revealed.
“Brain retractor.”
“yes!”
Ki-Seok Choi and the intern placed a brain retractor on Vera’s head.
“Now let’s approach the surgical site.”
Lucas moved the forceps while staring at the microscope.
His hand movements were unstoppable.
I dug into my head, which was filled with various cranial nerves and blood vessels, like it was my home. According to what Choi Ki-seok observed, Lucas is superior to Matthew in terms of his skill in approaching the surgical site.
Chii Iik.
Choi Ki-seok watched Lucas and sucked his blood with a suction device at the right time.
Even in situations where it would be better to use gauze.
This is to avoid wasting blood as much as possible as the surgery is performed without blood transfusion.
“Platelet hematocrit level is normal.”
“Good job. Please watch carefully in the future.”
Lucas smiled at Choi Ki-seok’s report.
Today, unlike other times, I couldn’t help but be sensitive to blood-related values. However, I felt relieved when Choi Ki-seok recognized this and mentioned it in advance.
After a long process, we arrived at the surgery site.
‘Seeing it in person makes it even more serious.’
Choi Ki-seok could not take his eyes off the surgical site.
Moyamoya disease is a disease in which part of the brain’s aorta gradually narrows and becomes blocked, causing abnormal blood vessels to grow from the blocked vessel.
The Japanese doctor who first saw this disease said that it seemed like abnormal blood vessels had formed all over the place, so it was given the name Moyamoya disease.
In Vera’s case, moyamoya disease had reached stage 5.
In short, there are a lot of places to fix.
“Let’s begin. 5-0 Dexson (absorbable suture).”
Gigigigigeek.
The moment Lucas tightened the needle with the needle holder, Cindy wrinkled her nose repeatedly.
It appears that the pain worsened while assisting.
Choi Ki-seok cleared his throat to show that he understood and prepared to assist Cindy.
The curtain on complex vascular anastomosis surgery has finally risen.
Today’s surgery is similar to CABG (coronary artery bypass grafting), but involves connecting the superficial temporal artery to the currently narrowed middle cerebral artery.
Through this, blood is supplied directly to the narrowed blood vessels.
Suuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu Chii Iik.
When Choi Ki-seok cut the middle cerebral artery with a scalpel, red blood flowed, and Cindy absorbed the blood with a suction device.
The two worked together to perform the same treatment on the superficial temporal artery.
‘What are you doing?’
Lucas took his eyes off the microscope and stared at the two people.
What the First had to do, the Second was doing what the Second had to do.
It looks clearly different from when practicing.
I felt like I wanted to point this out, but I held back for now.
Because the treatment itself was flawless and clean.
After the bleeding stopped, suturing began.
Lucas anastomosed the patient’s two thin arteries with sutures.
This is a critical moment when even if the suture needle goes astray just once, the blood vessel may be damaged even if the ligation is just a little strong.
Lucas’ hand movements actually shined.
He continued the delicate suturing work. However, as the suturing was about to be completed, the surgical site suddenly became stained with blood.
The pseudoartery caused by moyamoya disease ruptured.
‘this!’
Ki-Seok Choi tied the upper part of the pseudoartery with vascular forceps and performed suction with both hands.
His prompt action prevented the bleeding from getting worse.
“Whew… I almost lost my liver. How much blood is left in Cell Saver?”
“I don’t have much left. If I have one more bleeding like this, I don’t think I can handle it.”
“If it wasn’t for blood transfusion, there would be no problem.”
Lucas frowned as he looked at Cell Saber.
While the suturing was paused for a moment, Ki-Seok Choi carefully released the vascular forceps.
A small amount of blood flowed and then stopped.
Fortunately, the bleeding was successfully stopped.
“Now that the bleeding has stopped, let’s continue suturing.”
“yes!”
Ki-Seok Choi held the blood vessels undergoing anastomosis firmly to prevent them from moving.
Thanks to the fact that he fixed the blood vessel without shaking, Lucas’ suturing speeded up.
“This is a boring picture.”
Parker, who was watching the surgery, wrinkled his face and spoke.
“What do you think, as a brain tumor surgeon?”
“We don’t know yet. We’ll have to wait and see.”
“Once the anastomosis of the middle cerebral artery and the superficial temporal artery is completed, isn’t the surgery actually over?”
“That’s true. But there are always unexpected situations in surgery.”
Matthew stared at the monitor with a calm expression.
Just now, Cell Saver was briefly shown on the monitor, and the remaining blood was showing on the floor.
If bleeding occurs just one more time, the surgery will be a disaster.
‘flea. ‘If only it weren’t for you.’
Matthew’s gaze suddenly focused on Choi Ki-seok.
Somehow, he was handling a lot of the work that Cindy, the first assistant, had to do.
It means there is something wrong with Cindy.
If someone other than Choi Ki-seok had been the second assistant, the surgery would have progressed slowly…
Even if it wasn’t Parker’s request, the thought of cutting him out quickly became stronger.
click!
The cheerful sound of scissors spread through the rosette.
Finally, the difficult anastomosis was completed.
Lucas pressed the anastomosis site with forceps and checked for leaks with methylene solution.
The anastomosis was completed cleanly.
Now just close the surgical area and the situation is over.
“Everyone, don’t get excited and finish slowly. Okay?”
“yes.”
The staff answered simultaneously.
However, just as the surgical site was about to be closed, the anesthesiologist delivered the sad news.
“The patient’s intracranial pressure is rising. Blood pressure and pulse are dropping.”
“this!”
Lucas bit his lip and looked at the microscope.
The surgery was perfect, but what went wrong?
Even while examining the brain, the patient’s vitals continued to decline.
“Chief. There is bleeding in the Willis circle.”
“In Willis Circle?”
Hearing Choi Ki-seok’s words, Lucas looked at Willis Circle.
Indeed, blood was flowing from a branch of an artery in Willis Circle.
Complex vascular anastomosis is a surgery that supplies blood to blocked blood vessels.
As the blood suddenly flows, excessive blood accumulates in some blood vessels, causing bleeding.
“Cranial pressure continues to drop. Currently, patients with cerebral pressure of 60mm H2O are even showing symptoms of hyperventilation.”
“Administer mannitol and maintain the partial pressure of carbon dioxide above 28mmHg.”
“All right.”
“I’ll stop the bleeding while Mr. Choi and Cindy go to decompression.”
“yes!”
The staff moved in perfect order under Lucas’ instructions.
Bleep! Bleep! Bleep!
A dangerous sound spread throughout the rosette.
The blood stored in the cell saver has run out. There is still some necessary treatment left.
Lucas stared at Cell Saber with a painful expression.
The last bastion has collapsed. If blood is not transfused immediately, the patient is in critical condition.
“Chief, the decompression surgery is finished. The bleeding area is…”
“Damn it! Even if I suction or use a cautery, the bleeding can’t be stopped!”
Lucas was applying pressure to the bleeding area with cotton. Sometimes direct pressure is effective in hemostasis.
“I’m sorry, but I’m going to go outside for a moment.”
Choi Ki-seok asked for understanding and went out to Rosette.
The staff could not hide their embarrassment at his sudden behavior. What kind of treatment is meaningful now that Cell Saber’s blood reserves are depleted?
Jiiiing.
Eventually, the rosette door opened and Choi Ki-seok returned.
In his hand was a blood pack.
“Mr. Choi. What about that?”
“Chief, I can’t watch another patient die like this. I’ll start a blood transfusion right away.”
“…Yes. It can’t be helped.”
Lucas did not stop Choi Ki-seok from wearing a blood pack.
It is too harsh that a young patient should die not only because the surgery failed but because he could not receive a blood transfusion.
Soon, red blood flowed through the sap and into my veins.
The surgery ended when the subsequent emergency treatment was completed successfully.
* * *
That afternoon.
Matthew walked down the ward hallway whistling.
The steps heading towards Lucas’ office were unusually light.
‘Stupid bastard.’
When I thought of Lucas, who was so depressed, I couldn’t help but laugh.
Lucas’ surgery in the morning was virtually a failure.
The surgery itself was successful, but it was because of a blood transfusion.
Since the non-blood transfusion clause was specified in the surgical consent form, this was a clear failure of the surgery by the surgeon.
Even if a guardian files a medical lawsuit based on the fact that he or she received a blood transfusion, he or she has nothing to say.
Knock. Knock. Knock.
When I knocked, I heard a voice telling me to come in.
Lucas was sitting on the sofa in his office, drinking coffee.
“What’s wrong with you?”
“What happened? I came to comfort you.”
Matthew continued, looking at Lucas’ expression.
“That’s what I told you already. You dug your own grave by telling me not to do bloodless surgery for no reason.”
“It seems like you are completely mistaken about something.”
Lucas smiled coldly.
“The surgery was a success. There are no problems.”
“hey. “Are you that confident, even though numerous staff members in the observation room witnessed the blood transfusion?”
A sly smile appeared on Matthew’s lips.
“Ah… I think I finally know what you’re thinking. You are planning to deceive your guardian. Although he had a blood transfusion, he was trying to hide the fact from his guardian.”
“….”
“Has even Lucas in the world fallen to this point? You are the one who was willing to risk anything for patients and their guardians. But I will never stay silent. If you hide the fact that you received a blood transfusion, I will personally tell your guardian about the transfusion.” “Do it if you
want.”
Lucas showed his courage.
As the gazes of the two people clashed tightly, Matthew took the first step. He opened his mouth:
“Even though I had an argument with you a while ago, I’m still thinking about you. Just give up the head chief position. Then, I’ll let today’s matter pass quietly.”
“You haven’t been able to understand what I’m saying since a while ago. The surgery was a success and I have no intention of relinquishing the title to you. Do you know why?”
“Okay. Please explain with that proud mouth.”
“The blood transfused at the end of the surgery is the patient’s blood. In other words, it’s an autologous blood transfusion.”
“What? Autologous blood transfusion?”
“Yes. Mr. Choi had previously collected the patient’s blood with the consent of the guardian. It was so unusual that I had not even thought about it. Usually, guardians who want no blood transfusion even refuse autologous blood transfusion.”
Lucas took a sip of coffee and continued.
“I heard the threat very well. I’m becoming more and more convinced that I was right to draw a line with you.”
“….”
“I don’t have anything more to say, so can you just get out of the way?”
At Lucas’s gesture, Matthew left the office in vain.
Soon, his face became sad . “ You damn
bastard. Are you fucking me again?”
