Counterattack (2)
“The patient is Leah, a 5-year-old girl. A few months ago, I was hospitalized for Kawasaki disease at our cardiology department. “Afterwards, during an ultrasound examination conducted while following the patient’s condition at an outpatient clinic, a 3-centimeter aneurysm was discovered in the left and right coronary arteries.”
Charles continued the briefing clearly.
The briefing was so angled that it felt like I was looking at the chart myself.
‘It won’t be easy.’
Choi Ki-seok bit his lip without realizing it.
Kawasaki disease.
This disease is an acute vasculitis of unknown cause that occurs in children.
Because many of the symptoms overlap with those of a cold, parents often misunderstood it as a cold.
In Lia’s case, she was already hospitalized and received immunoglobulin and aspirin treatment for two weeks.
However, his condition did not improve, so he had to undergo surgery.
Today’s surgery is CABG (coronary artery bypass grafting).
This is a surgery to adjust stenotic coronary arteries and connect new blood vessels.
“…This concludes the briefing.”
“That’s great.”
Kwon Il-soo patted Charles on the shoulder with a satisfied smile.
Then he crossed his arms and looked at the staff.
“Actually, there is something I couldn’t tell you. “While examining the patient, I twisted the direction of the knife slightly.”
“What do you mean by that?”
Choi Ki-seok asked with wide eyes.
The direction of the house is also twisted… I
‘ve been practicing a lot, but this is the first time I’ve heard this expression.
Kwon Il-soo, who values patients, would not have suddenly canceled the surgery, but I was curious about the hidden meaning.
“Ever since I first decided to have surgery, I have been thinking about what was best for the patient. “I don’t know if you will believe it, but I had a restless night until last night.”
“….”
“I’ll tell you the conclusion first. “Today’s surgery will be performed through OPCAB.”
The staff’s faces turned pale at Kwon Il-soo’s bombshell declaration.
OPCAB (Official heart-lung machine coronary artery bypass grafting).
This means that coronary artery bypass surgery will be performed, but heart-lung machines will not be used.
“professor. Are you saying you would like to perform OPCAB on a child?”
Kwon Il-soo nodded in response to Choi Ki-seok’s question.
“If it is an adult, OPCAB may be performed based on the patient’s condition. But Lia is still young. “The difficulty of surgery will skyrocket.”
“What’s important is not the level of difficulty, but the patient’s progress.”
Kwon Il-soo spoke clearly.
“First of all, Leah’s current status is sufficient to handle OPCAB.”
“….”
“Also, as everyone knows, Kawasaki disease is acute vasculitis. “Is there anyone here who doesn’t know that a side effect of a heart-lung machine is a systemic inflammatory response?”
In response to Kwon Il-soo’s question, the staff, including Choi Ki-seok, remained silent.
It was like giving silent consent to his words.
However, performing CABG on a patient with vasculitis, which could put a strain on the blood vessels, was not a very good idea.
“In that sense, today’s surgery will be performed through OPCAB. I have already finished talking with the guardian and received the consent form. “All we have to do is treat the patient safely.”
“yes!”
“All right.”
Kwon Il-soo’s smile returned to the staff’s brave response.
Buck. Buck. Buck. Buck.
The staff all began scrubbing their hands and arms with povidone-covered brushes.
Ki-Seok Choi, who was scrubbing, suddenly caught sight of Il-Soo Kwon.
His bold decision was surprising.
I never thought I would change the surgical method I had already decided on right before the surgery.
This meant that Kwon Il-soo was concentrating his attention on the patient.
‘You were thinking of the patient until the very end.’
Ki-Seok Choi gained new insight through Il-Soo Kwon.
“That’s amazing. “If it were Professor Benson, this would never happen.”
Charles, who was scrubbing next to me, spoke up.
“Are all thoracic surgeons in Korea like this? “You, Professor Kwon, and Deputy Director Song Myeong-jin are all like that.”
“Do you think there is anything different about Korea?”
“….”
“Wherever people live, they are all the same. “Just as there are good Americans and bad Americans.”
“Then how will you explain the Korean doctors at our hospital?”
“Could it be that like-minded people got together by luck?”
Choi Ki-seok burst out laughing.
Jiiiing.
The rosette door opened and the staff went inside at once.
Preparations for the surgery proceeded smoothly with smooth movements.
“Is this difficult? “You suddenly changed the surgical method without saying anything.”
Anesthetist Lewis frowned as he looked at Kwon Il-soo.
“I am sorry. I didn’t mean to embarrass Lewis. “The staff was also notified right before the surgery.”
“what. Then I have nothing to say. If it were a pediatric OPCAB, anesthesia would be difficult and vital management would not be easy…”
“An ordinary anesthesiologist would have done that.”
“I don’t know if I should be happy or sad about this? It’s nice to be praised, but my burden has increased thanks to it. Anyway, I’ll do my best.”
“yes. please.”
Kwon Il-soo watched Lewis heading behind the curtain.
Lewis is one of the reasons for switching to OPCAB for this surgery.
Lewis is an anesthesiologist who worked at Mayjo and is one of the top five most skilled anesthesiologists in the United States.
What if he didn’t help with this surgery?
OPCAB probably never even dreamed of it.
Surgeon is not the only one struggling with difficult surgeries.
The anesthesiologist’s ability to manage vitals also becomes important.
However, the importance of anesthesiologists tends to be somewhat obscured by being hidden behind a curtain.
“Mean arterial pressure is 100 mmHg and heart rate is 100 beats. Anesthesia will be induced. “Administer midazolam 2mg and sufentanil 2μg/kg intravenously.”
“….”
“Anesthesia induction is over.”
Kwon Il-soo nodded at Lewis’ report.
A tense tension flowing through the rosette.
When Kwon Il-soo decided on OPCAB, the difficulty level of surgery skyrocketed. If any member of the staff was caught off guard, it could snowball and engulf the surgery.
gulp.
The staff, except Kwon Il-soo, swallowed their saliva as if they had made a promise.
“From now on, we will perform OPCAB for bilateral coronary artery stenosis caused by Kawasaki disease.”
Following Kwon Il-su’s words, Charles disinfected the patient’s chest and covered it with a cloth.
Followed by median sternotomy.
Leah’s delicate skin was split and retractors were attached to the incisions.
As Jeremy and the intern pulled the retractor left and right, the incision was expanded, widening the surgical field of view.
In that state, when the lungs were pulled aside, the heart was revealed.
thud. thud. thud. thud.
Leah’s heart beats.
Leah’s heart will be beating non-stop during today’s surgery. As if cheering on the soldiers trying to save her.
“The stenosis is severe compared to the age. Moreover, there is stenosis on both the left and right….”
“It will not be an easy fight.”
Choi Ki-seok and Kwon Il-soo looked down at the stenosis and exchanged opinions.
The stenosis areas were the left anterior descending artery and the right circumflex artery.
As a stenosis occurred here, part of the heart was not properly supplied with blood.
“Shunt.”
Choi Ki-seok took a small needle and pushed it into the stenosis area.
This is to ensure smooth blood flow during surgery.
“Which area are you considering for the graft (blood vessel harvest)?”
“I’d like to hear your opinion first rather than mine.”
“I think…”
Choi Ki-seok paused before continuing.
“I think the internal mammary artery and radial artery would be good. The internal mammary artery is the easiest choice, but I think it would be best to anastomose it to the left stenosis and the radial artery to the right stenosis.”
“Same as me.”
Kwon Il-soo’s eyes smiled.
“Then let’s change places for a moment. Dr. Choi stands in the Charles position and performs the radial artery graft. “Charles helped me do the internal mammary artery graft.”
“All right.”
Two people’s grafts started at the same time.
Ki-Seok Choi examined the condition of the left radial artery using the Allen test.
Since we knew in advance that Leah was right-handed, we planned to take a blood vessel from her left arm.
“It looks like there’s no problem?”
“I think so too.”
Choi Ki-seok added a word to Jeremy’s words.
After the test was completed, the patient’s hands turned red.
This is a sign that there is no problem with the radial artery circulation.
Suuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu
Choi Ki-seok cut the patient’s left wrist with a scalpel and began harvesting the radial artery. Since the harvested artery was directly connected to the coronary artery, it was necessary to make a clean cut surface.
I moved the scalpel as carefully as possible.
“Phew….”
He placed the collected blood vessel on the bench and stared at Kwon Il-soo.
Kwon Il-soo was still working on the graft.
The internal mammary artery is located in the ribcage and is hidden in the costal cartilage and fascia.
Under normal circumstances, the blood vessel would have been removed without difficulty, but now OPCAB is in progress.
This means that the blood vessels near the heart are removed while the patient’s heart is beating.
Naturally, the graft difficulty level had no choice but to increase.
“Charles. “Focus!”
“Sin… I’m sorry.”
Charles accidentally missed the blood vessel he was holding with forceps.
Thanks to this, the internal mammary artery ended up hiding in the cartilage and fascia again.
“It won’t work. “Mr. Choi, come back to first.”
“yes.”
Ki-Seok Choi switched places with Charles and took the first assistant position.
Thanks to his unwavering hand movements, Kwon Il-soo completed the internal mammary artery dissection in an instant.
“sorry. “Because I’m not good enough…”
When the peeling was over, Charles started crying with a downcast look on his face.
“It’s not your fault. If CABG had been performed as scheduled, this mistake would not have occurred. But…”
“….”
“A doctor never knows when and what kind of patient he will face. Sometimes, ridiculous emergencies occur. So, just for that time, you need to sharpen your skills on a regular basis. Do you understand?”
“yes. “I will keep that in mind.”
While the two were talking, Ki-Seok Choi stared at the patient monitoring device.
‘That’s strange. what?’
Apparently, until a few minutes ago, the patient showed symptoms of low blood pressure and low body temperature. So, I was wondering at what timing I should tell this to Kwon Il-soo.
Surprisingly, the patient’s vitals returned to normal in a short period of time.
Should I say that it is like a ghost crying?
“Then let’s continue with the surgery.”
The surgery resumed with Kwon Il-su’s words.
‘It’s pretty good, right?’
Lewis’ eyes were fixed on Choi Ki-seok seen through the gap in the curtain.
Usually, surgeons do not pay much attention to the patient’s vitals.
The surgeon’s job was surgery, and checking vitals was the anesthesiologist’s role.
The only time a surgeon pays attention to vitals is when there is a problem with them.
Nevertheless, Choi Ki-seok carefully monitored the patient’s vitals and monitored the patient monitoring device throughout the surgery.
This means that surgery is viewed broadly.
Now I think I understand why Choi Ki-seok is always at the center of topics.
In the first place, isn’t it absurd that first-year residents are first admitted to OPCAB?
Lewis smiled faintly as he looked at Choi Ki-seok, who was confused.
Because low blood pressure occurred, the rate of norepinephrine administration was adjusted and hypothermia was controlled with a fluid warmer.
Of course, Choi Ki-seok doesn’t know that fact.
‘This surgery. It might end easier than you think…’
Lewis muttered to himself as he looked at the patient monitoring device.
