Counterattack (3)
With the graft collection completed successfully, the first step of OPCAB began.
“Charles, try tightening the epicardial clamp. “My heartbeat is still strong.”
“All right.”
Charles tightened the retainer screw under Kwon Il-su’s instructions.
The heartbeat was somewhat restricted as the frame of the fixture compressed the heart.
“This game starts now. Teacher Choi, please come to your senses too.”
“yes!”
Ki-Seok Choi nodded vigorously and used a scalpel to make a hole about 3 millimeters in the aorta.
Afterwards, the end of the collected internal mammary artery was aligned with the aortic hole.
I felt a strange sense of pleasure as my blood vessels fit together like puzzle pieces.
“5-0 Prolene.”
Gigigigigeek.
Kwon Il-soo tightened the suture needle with a needle holder and began suturing.
thud. thud. thud. thud.
A suturing procedure performed in conjunction with a pulsating heartbeat.
Kwon Il-soo and Choi Ki-seok’s gaze never left the blood vessel being sutured.
The hands of the two people did not show the slightest movement, as if they were not affected by the heartbeat at all.
If you look at the suturing alone, it looked like CABG was being performed, not OPCAB.
Chii Iik. Chii Iik.
The surgery went smoothly as Charles and Jeremy sprayed the chest and administered suction at the right time.
“Edge anastomosis completed.”
Choi Ki-seok said briefly and stretched out the internal mammary artery connected to the aorta. After placing this at the bottom of the stenosis area, a hole was made in the blood vessel in the same manner as before.
‘It exceeded my expectations.’
Kwon Il-soo glanced at Choi Ki-seok and started anastomosis on the other side of the remaining grafted blood vessel.
To be honest, I didn’t know he could handle the OPCAB assistant perfectly.
Isn’t this a situation where the patient’s heart is beating violently?
Nevertheless, it was surprising that he was calm and providing thorough assistance.
In fact, I was planning to call in a fellow separately if Choi Ki-seok’s assistance was not adequate, but there was no need to do so.
That’s how the left coronary artery bypass surgery ended.
Blood flow from the aorta has now moved to the bypass vessel rather than the existing stenosis site.
Bleep. Bleep.
The staff’s faces stiffened at the sudden mechanical sound.
Their eyes turned to the patient monitoring device as if it were a promise.
Pulmonary artery pressure and pulmonary capillary wedge pressure were abnormally elevated.
“professor. Something is strange. The anastomosis was perfect and blood flow was normal, so why…”
Choi Ki-seok was speechless after using the Eye of Hippocrates on the patient.
There was nothing that Hippocrates could see.
This means that additional diseases did not arise due to surgical problems.
So then, for what reason does the patient have abnormal blood pressure levels?
“….”
Kwon Il-soo also remained silent, probably because he couldn’t find the answer.
The operation was temporarily halted due to an unexpected reef encounter. If the blood pressure could not be controlled, the surgery could not proceed further.
“Please adjust the position of the fixture. “If you just send it to the right instead of now, there won’t be any problem.”
Lewis, who had not said a word since the start of the surgery, opened his mouth.
“Will the pulmonary artery pressure and pulmonary capillary wedge pressure be controlled to that extent?”
“You’ll know when you try.”
Lewis on the other side of the curtain exuded confidence, and Ki-Seok Choi personally corrected the position of the fixture.
After about five minutes, my blood pressure levels returned to normal.
Just by changing the position of the fixture, the blood pressure returned to normal…
Choi Ki-seok felt like he was a child who was exposed to magic for the first time.
“How did this happen?”
“This sometimes happens when performing left internal thoracic artery bypass surgery on a patient wearing a compressible epicardial fixator.”
“….”
“If the left ventricle is compressed and the heart is rotated violently to expose the coronary artery, changes in blood flow occur. So, all you have to do is touch the fixture that is causing it.”
Ki-Seok Choi stuck out his tongue at Lewis’s straightforward answer.
Just from what I said just now, I could tell that Lewis was no ordinary person.
His answer contained insight into the surgical process.
What would it have been like if an incompetent anesthesiologist had been here?
Couldn’t the surgery have been aborted because the blood pressure couldn’t be controlled?
“thank you. Louis.”
“This is my job.”
At Kwon Il-soo’s words, Louis waved his hand as if it was no big deal.
After some twists and turns, right coronary artery bypass surgery was performed.
There was no difference in procedure between right coronary artery bypass surgery and left coronary artery bypass surgery.
The point is that the radial artery, not just the internal mammary artery, is used as a bypass.
The only difference was that it was a continuous suture rather than a simple interrupted suture.
‘As expected, he’s a professor.’
Ki-Seok Choi looked at Il-Soo Kwon’s sutures and felt his class firsthand.
The difficulty of continuous suturing when the heart is racing skyrockets. Nevertheless, Kwon Il-soo performed a calm and meticulous suturing technique.
Can he really be considered a master of pediatric thoracic surgery?
But that’s the moment.
Bleep. Bleep.
An ominous electronic sound flows once again.
Choi Ki-seok checked the patient monitoring device and let out a sigh of despair.
This time, cardiac output and blood pressure were falling simultaneously.
Sudden arrhythmia and conduction disturbances.
As before, an unfortunate incident occurred even though there were no defects in the surgical process.
Indeed, pediatric OPCAB was a mountain that could not be easily overcome.
“wait a minute. “Please stop suturing.”
Lewis opened the curtain and peeked out his face.
“I’ll lower the patient’s head first. Dobutamine and dopamine are administered intravenously.”
Lewis took quick action.
After experiencing his miracle once, the staff believed that his vitals would return to normal.
However, his vitals were only slightly better than before the treatment.
We are still like a candle in the wind.
“This is all I can do.”
Lewis drew a firm line.
As a result, the staff’s attention focused on Kwon Il-soo.
An emergency situation that is beyond the hands of an anesthetist. Responsibility for this rested entirely with the surgeon.
‘Lewis is right. This is Surgeon’s territory.’
Choi Ki-seok gave Lia a small nod after using Hippocrates.
Arrhythmia and ischemic heart disease were added to Lia’s diagnosis.
There was a lot of tension as the surgery was temporarily suspended.
The staff couldn’t open their mouths and their hands were hovering in the air as they had nothing to do.
“professor. What should we do now?”
“What should I do? What should I do?” “I have to continue with the surgery.”
Kwon Il-soo took up the scalpel again.
“The patient is suffering from transient ischemic heart disease. “From now on, we will control blood flow as much as possible.”
“….”
“Insert an additional shunt into the stenosis area on Dr. Choi’s right side. Then, blood circulation in the stenosis area will become smoother. “Also loosen the clamp (vascular forceps) that holds the aorta together.”
“If the clamp is removed and bleeding occurs during suturing…”
“Of course, you have to suture it to prevent bleeding.”
Kwon Il-soo confidently responded to Choi Ki-seok’s words.
“Charles and Jeremy prepare for IP (Ischemic Preconditioning), and Lewis reports coronary blood flow every minute through echocardiography.”
Kwon Il-soo immediately took control of the staff.
His words were full of confidence that he could save the patient, and the staff were infected by his passion and confidence.
The staff members move as one body under Kwon Il-soo’s orders.
The treatment was carried out quickly and without further conversation, as they said they knew what was going on just by looking at the eyes.
“The patient’s cardiac output returned to normal.”
The staff members’ faces turned bright red after Lewis’ report.
Would this be what it would feel like if a train heading towards a cliff stopped at the edge of the cliff?
“Don’t get excited. “It’s too early to be happy.”
“yes!”
“Finishing the suturing procedure.”
Kwon Il-soo continued with right coronary artery bypass surgery.
As time passed, a total of 5 hours of arduous surgery came to an end.
The surgery was flawless and his vitals were calm.
Jiyiing.
The steps of the staff leaving the operating room were particularly light.
* * *
Rest room immediately after surgery.
Choi Ki-seok was sitting on the sofa with Kwon Il-soo and drinking an energy drink.
The surgery was completed after overcoming two hurdles.
That excitement still lingered in my body.
Ki-seok Choi noticed that the hand holding the energy drink was shaking and laughed.
“professor. Thank you for your hard work.”
“It’s hard. There were more teachers like Choi and the other staff than me. “Because I insisted on OPCAB, surgery became difficult.”
“Thanks to this, the patient’s outcome improved. “I think it is natural for a true doctor who cares about his patients to follow the professor’s wishes.”
Choi Ki-seok stared at Kwon Il-soo blankly.
In the operating room, he looked as big and majestic as a mountain, but now he just looked like a tired old man.
Although he is the same age as his teacher, he has not yet put down a scalpel.
Maintaining sharp concentration throughout the surgery.
The heart that thinks of patients is as passionate as a first-year doctor.
There was a lot to learn from Kwon Il-soo.
Will he be able to remain as a cool writer in the future?
Suddenly a thought crossed my mind.
“Anyway, I guess I’m getting old too. “My stomach hurts just because I finished the surgery.”
“It was a very difficult surgery.”
“Hmm… I guess it sounds like they’re trying to pamper me even more.”
Choi Ki-seok burst out laughing at Kwon Il-soo’s joke.
“professor. The patient developed ischemic heart disease while undergoing right coronary artery bypass surgery. “I wonder how you figured out how to deal with it so quickly.”
“I don’t think it will help if I say this, but I can’t help it.”
“….”
“It’s all experience. If you undergo surgery for a long time, you will get a sense of what should be done and what should not be done. “There’s no way to explain that.”
“okay.”
“I already know that Dr. Choi’s greed for surgery is the best in the world. But just as rice needs time to ripen, so does a rice cooker need time and experience.”
“I’ll keep that in mind.”
After the conversation, there was silence for a moment.
Choi Ki-seok was the first to speak.
“Do you know the anesthesiologist who came to Rosette today?”
“You mean Lewis? We don’t know each other. “I heard he was transferred to MHC not long ago, but he just happened to be in our surgery.”
“I think I’ve never seen an anesthesiologist so good at managing vitals.”
Lewis caught low blood pressure and low body temperature without anyone knowing.
In addition, the cause of the suddenly abnormal blood pressure was identified.
Plus, the way he accurately drew a line between the roles of surgeon and anesthesiologist…
The more I thought about it, the more surprising I was at his performance.
“It’s worth it. Because I was surprised to see Louis too. As you know, surgery is not something the surgeon does alone. “Only when department staff, nurses, anesthetists, and cardiopulmonary technicians work together as one can we achieve good results.”
“….”
“It’s not for nothing that we assemble a team when performing a highly difficult surgery.”
After finishing speaking, Kwon Il-soo’s bitter smile appeared on his lips.
From that sight, Choi Ki-seok realized something.
He was thinking about the failed Norwood team project.
“what. “I don’t know if I’m qualified to say this.”
“The Norwood team’s failure was not your fault. In the first place, the difficulty of Norwood surgery cannot be compared to Saber surgery. Just…”
“Just?”
“I think the problem was that Professor Hyukpil Jang felt competitive and chose Norwood surgery as his project surgery. “It was my judgment that Norwood was not suitable for project surgery.”
“what. Thanks to that, when I tried to press the bridge of his nose, only my nose fell down.”
Jiiiing.
Choi Ki-seok’s call phone suddenly rings.
Choi Ki-seok asked for Kwon Il-soo’s understanding and connected the phone.
“Jenny. Have you arrived at the hospital?”
