Hectic schedule (4)
“My neck hurts so much. “It feels swollen and it’s really hard to breathe.”
“The endoscopy results showed that a mussel shell was stuck in the esophagus. “Did you go to the emergency room right after eating?”
“That’s not true.”
The patient shook his head.
“I think I ate the mussel dish about four days ago. At first, I thought I was just pretending, but the pain got worse and worse… What happens to me now?”
“I will remove the mussel stuck in your esophagus.”
“Seo… Are you really going to have surgery?”
The patient’s eyes widened, and the guardian nearby also started shaking.
“yes. We need it right now. For esophageal damage, like other diseases, there is a golden time. Unfortunately, the patient passed the golden time of 24 hours.”
“….”
“There was also significant inflammation in the esophagus. There are two ways to remove a mussel lodged in your esophagus. One is using an endoscope and the other is making a surgical incision…” “
Sir. Please do it through an endoscope!”
The patient urgently cut him off.
“I’m scared to touch a knife. “Please do it in a way that doesn’t hurt.”
“The golden hour has passed, so endoscopy is impossible. “If you use an endoscope, you may end up creating another wound at the inflamed area.”
“Then I…”
“Yes. The mussels must be removed through surgical incision.”
“Please think again. “Even if you use an endoscope, there may be no scars.”
“teacher. “I also want my husband to get an endoscopy.”
The guardian, who was silent, gave strength to the patient.
Choi Ki-seok looked at the patient and guardian carefully.
There are surprisingly many cases where patients and guardians insist on specific treatments. In addition, there are many people who try to stay on top of the doctor’s head, telling him to leave his stomach.
However, doctors should not be swayed by patients and guardians.
We must listen carefully to what they say, but establish firm principles for treatment.
“The mussels will be removed surgically. “Please print out the intern surgery consent form.”
“All right. By the way, teacher. “Wouldn’t endoscopy be better if patients and their guardians want it?”
“that’s right. “What’s the problem with doing whatever I want with my body?”
“teacher. “Please do it through an endoscope.”
At the intern’s words, the patient stormed in, asking what was wrong, and the guardian joined in.
“Patient. “Why did you come to the hospital now?”
“Are you asking because you don’t know that? Of course I came because I was sick.”
“So, didn’t you come to the hospital because you were in a state where you couldn’t control your own body?”
The patient became dumbfounded by Choi Ki-seok’s comments.
“I know the patient’s body better than the patient himself. At least when it comes to this disease. “I assure you that surgical treatment is more helpful to the patient’s progress now than endoscopy.”
“….”
“Please stop being stubborn and follow what I say.”
At Choi Ki-seok’s words, an earthquake occurred in the eyes of the patient and guardian.
The two exchanged glances for a while and then nodded as if they had decided.
“All right. “I will follow your instructions.”
“Please take care of my husband.”
“Well thought out. “There is no need to be afraid of surgical procedures.”
Choi Ki-seok called the thoracic surgery department, called the on-call intern, and set up an operating room.
“wow. “You’re amazing, teacher.”
The intern who printed out the consent form approached him and spoke to him.
“If there is a choice of treatment, it is usually done according to the wishes of the patient or guardian. “But this is the first time I’ve seen Mr. Reggie push forward in such a charismatic way.”
“Did you?”
Choi Ki-seok burst into laughter.
“That’s what I think. It is right for the doctor to make the decision and for the patient to trust the doctor. However, there is only one condition attached to this.”
“What are the conditions?”
“That’s right… a doctor must truly care for his patients. Only then will treatment be provided for the patient. Otherwise, patients always receive expensive treatment or treatment that is convenient for the doctor, right?”
“Hmm… After listening to it, what you said makes sense.”
The intern rubbed his chin and tilted his head.
“But if you think about it from the patient’s perspective. “How do I determine whether the person treating me is a good doctor or not?”
“That may be something doctors need to work on. “If there are more doctors who treat their patients with sincerity, wouldn’t the image of doctors change a lot?”
“It won’t be easy.”
“I agree.”
Ki-Seok Choi finished talking with the intern and went up to the operating room.
Mark, the cardiothoracic surgery intern on duty, was standing in front of the pre-set A rosette.
“You came here after looking at the charts, right?”
“yes. I saw it two or three times. But is it really okay for you and me to be together?”
“don’t worry. “Nothing will happen.”
Choi Ki-seok used encouragement skills to stabilize Mark.
In fact, esophageal incision is not a very easy surgery.
It is not a surgery that a first-year resident can perform alone. However, he was confident that he could complete the surgery safely.
In the meantime, I have undergone numerous surgeries that are beyond my capabilities.
Compared to those, esophageal incision surgery was rather less difficult.
While we were talking, a patient came up from the emergency room.
Buck. Buck. Buck. Buck.
The two finished scrubbing and entered the rosette with the patient.
The staff for this surgery was Choi Ki-seok, Mark, and nurse May, and unlike other times, it was simple.
If you call a lot of staff, the staff who are called have a hard time.
Choi Ki-seok knew this and was as considerate as possible.
“As expected, it’s a famous Fanta. “I never thought I would receive an esophagostomy patient at 9 p.m.”
“That’s my charm, right?”
“Anyway, I can’t stop Dr. Choi. “Not even my daughter-in-law can stop me.”
Choi Ki-seok and Mark burst into laughter at May’s joke.
Preparation for surgery soon ended.
Choi Ki-seok stood in his chair and cracked his neck.
“From now on, we will perform an esophageal incision to remove foreign objects stuck in the esophagus.”
Following his words, Mark disinfected the patient’s neck and chest area and covered it with a cloth.
“Meth.”
With the scalpel handed to me by May, I cut down from the bottom of the patient’s neck to the solar plexus.
The skin cracked as fragile as a piece of paper.
Choi Ki-seok worked with Mark to fix the retractor on the incision site and spread it left and right.
As the incision was opened, the surgical site became visible at a glance.
Today’s surgery site: the esophagus.
The esophagus is an organ located between the pharynx and the stomach and serves to pass food to the stomach and prevent reflux of food.
In the patient’s case, it was assumed that a mussel was lodged in the upper esophagus.
“teacher. “Can’t you see the mussel shell?”
“If you can’t see it, you have to make it visible.”
Choi Ki-seok used forceps to slightly push the bronchial tube to the side. Then, the mussel shell hidden behind the bronchi shyly revealed itself.
The size of the mussel shell stuck in the esophagus is approximately 2.5 centimeters.
A red inflammatory reaction was seen in the surrounding area.
“It’s terrible to live with something like this for four days.”
The intern shook his head, and May nodded vigorously as if she sympathized.
“Meth.”
Choi Ki-seok made an 8-centimeter incision centered on the area where the foreign object was embedded. If you recklessly try to extract a foreign body without making an incision, secondary esophageal damage could occur.
Ki-Seok Choi, who made an incision, grabbed the mussel shell with forceps.
I pulled it slightly, but the mussel’s resistance was surprisingly strong.
I received his strength tightly, as if it were a tug-of-war.
‘If you say so, it’s a mussel.’
Choi Ki-seok carefully shook the mussel from side to side to secure space, then pulled it with appropriate force.
Empty!
The mussel shell fell on the bench and made a clear sound.
This concludes the essential treatment!
“teacher. I think the surgery was easier than I feared. “It’s hard to tell you this now, but I think I can do it too, right?”
“Really? “There is no job better than a doctor to attract people.”
“Honestly, shouldn’t I just make an incision, remove the mussels, and sew it up again?”
“Easier said than done.”
Choi Ki-seok continued speaking with a calm expression.
“Did you see me cutting the esophagus?”
“yes. “Didn’t you just scratch it off?”
“no. First of all, when making an esophageal incision, the texture of the esophageal muscles must be aligned. Additionally, choosing the direction of esophageal incision is important. The incision direction largely includes the anterior part (11-1 o’clock direction), the posterior part (5-7 o’clock direction), and the small part (3 o’clock direction).”
“….”
“Then here’s the quiz again. “Why did I make an incision in the posterior part?”
Mark blinked his eyes in silence at Choi Ki-seok’s question.
His gaze said this.
I don’t know anything~ I really don’t know anything~
“The Angle of His is at 8 o’clock. This is because avoiding this direction can prevent reflux from occurring in the gastroesophageal tract. “Can I tell you one more thing?”
Choi Ki-seok continued speaking rapidly.
“The depth of the incision is as important as its direction. You need to decide whether to incise the entire thickness of the esophagus or just a portion of it. “Do you still think I just brushed it off?”
“…I was wrong.”
Mark lowered his head.
On the surface, Choi Ki-seok’s treatment was nothing special. However, after listening to it, I realized that there was hidden anatomy knowledge that I had never known before.
It’s not called ‘Seojeon’ for nothing.
That thought crossed my mind.
“I didn’t bring this up to scold you. However, when performing treatment, you need to properly know why you are doing it.”
“I’ll keep that in mind.”
“ruler. Then shall we keep going? 4-0 vicryl.”
Choi Ki-seok tightened the suture needle with a needle holder and then sutured the incision.
Simple continuous suturing performed with light hand movements.
In addition, gastric fundoplication to prevent gastroesophageal reflux was performed smoothly.
As time passed, the curtain on esophagostomy came to an end.
“Both Mark and May had a hard time. “I will suture the chest incision and have a cup of coffee.”
“Um… there, teacher! “I think I left out something important.”
At Mark’s shout, Choi Ki-seok and May’s attention focused on him.
“What are you talking about. “Is the surgery all over?”
“After surgery, there is a procedure to check for leaks at the suture site, but that was missed.”
“…Is it okay?”
Choi Ki-seok, who had been waiting for Mark’s comment, smiled and nodded.
He wasn’t one to forget to check for water leaks.
I deliberately skipped the last step because I wanted to see what kind of mindset Mark had when assisting.
“You’re right. As important as surgery is the procedure to check whether the surgery was successful. “There are a lot of patients who suffer from complications or die due to aftereffects after surgery.”
“….”
“I guess you weren’t just blanking out?”
“I, too, am a member of the surgical staff. “I don’t think I’m someone who just runs errands next to you.”
“good. “Keep that mindset until you get the scalpel.”
Click!
Ki-Seok Choi tied the lower part of the esophagus with forceps and then submerged the esophagus in saline solution. In that state, air was injected into the esophagus to check for air leaks.
Of course, there was no leak.
Choi Ki-seok, who confirmed the water leak, completed the surgery by sewing up the open incision through a median thoracotomy.
A first-year resident achieved an achievement that others would find hard to believe: successfully completing an esophagostomy with only the help of an intern and a sterilizing nurse.
Eventually, the three people left the rosette with light steps.
‘I also want to become a doctor like Dr. Choi.’
Mark, who was moving the patient’s bed, could not take his eyes off Ki-Seok Choi, who was ahead of him.
