at Sewon Hospital (1),
Ki-Seok Choi paid close attention to managing the patient’s vitals.
First, the type of fluid and amount of drops were adjusted, and third-generation antibiotics were administered to control sepsis.
At the same time, we called the ward and gathered people capable of emergency surgery.
The moment Rosette was confirmed, three people were sent to the emergency room.
Hyun Lee, Pulmonary Esophageal Surgery Fellow.
Chief Resident Daniel Lee.
The youngest resident, Yongjun Shim.
These three people were the main characters.
“teacher. “Can we save our child?”
The guardian, who had been silent, stared at Choi Ki-seok with tearful eyes.
After signing the consent form for surgery, her emotional ups and downs worsened.
From her perspective, the current situation must be as bleak as being struck by lightning out of a dry sky.
I took my child on a picnic for a long time, and I bought him some nitrogen snacks that he found fascinating. Who would have imagined that such a terrible result would occur?
“yes. I will definitely save you. “Don’t worry too much.”
“thank you! thank you!”
Ki-Seok Choi and the staff moved to the operating room, greeted by a guardian whose head almost touched the ground.
“Chief. I don’t dare say this, but…”
Fellow Lee Hyun paused before continuing.
“If you boast that you will save the patient, wouldn’t you be able to hear resentment later?”
“Normally, that would be the case. But I don’t want to create an escape hole. “It’s about setting up a drainage camp and performing surgery.”
“Ah…”
Lee Hyun nodded as if impressed by Choi Ki-seok’s words.
“By the way, aren’t you the only pulmonary and esophageal surgery fellow training in our department?”
“yes. That’s right.”
“Did you check the patient’s chart? “If you were a surgeon, tell me how you would treat your patients.”
Lee Hyun could not hide his embarrassment at Choi Ki-seok’s point.
“ah. hmm. “That’s…”
Choi Ki-seok smiled bitterly as he watched Lee Hyeon roll his head while making a fuss.
If he wasn’t there, Lee Hyun would have had to treat this patient.
The problem was that looking at Lee Hyun’s attitude, the patient’s future was like a video even if he didn’t see it. It would be a shame if a hospital specializing in thoracic surgery could not cover even this much…
“I am sorry. I do not know.”
“Didn’t you study esophageal perforation?”
“….”
“Let’s talk with me after it’s over.”
While we had a short conversation, the group arrived at the operating room.
Buck. Buck. Buck. Buck.
After finishing scrubbing, the staff entered the rosette with the patient.
Procedures such as timeout to check the patient, connection to the patient monitoring device, general anesthesia, and preparation of surgical tools continued smoothly.
“How are the patient’s vitals?”
“Blood pressure is 120/70 mmHg, pulse rate is 70 beats/min, respiratory rate is 17 beats/min, and body temperature is 37.2 degrees. “Compared to the beginning, we caught a lot more.”
“great.”
Choi Ki-seok nodded at the anesthetist’s report.
“We will now begin esophageal anastomosis for esophageal perforation.”
“yes.”
Shim Yong-jun disinfected the surgical area and covered it with a cloth.
Suuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu.
Choi Ki-seok made a straight line from the patient’s neck to his chest with a scalpel. If only esophageal perforation had been treated, a tracheostomy would have been performed, but the patient was also suffering from mediastinitis.
Treatment of perforation and mediastinitis had to be done simultaneously.
Therefore, it was necessary to perform median sternotomy.
After inserting a retractor into the incision and opening it to the left and right, the surgical site was revealed.
“Hyun, drain the inflammation in the mediastinum. Yongjun helps, and Daniel works with me to fix the esophageal perforation.”
“All right.”
Under Choi Ki-seok’s instructions, the full-scale surgery began.
‘Is this okay?’
Lee Hyun checked the mediastinum swollen with inflammation and stuck out his tongue.
To exaggerate slightly, the inflammation in the mediastinum was as big as a camel’s hump.
It felt like pus would pour out like a torrent if I removed it. However, his eyes narrowed as he examined the treated area.
“Chief.”
“why?”
“There is necrotic tissue on the skin on the left side of the mediastinum.”
A black, dead area was noticeable at a distance from the inflamed tissue.
“Necrotic tissue and nearby areas are clearly exposed. “If it is removed clumsily, the patient will develop sepsis.”
“yes.”
Lee Hyun took a scalpel and made a cross incision on the area with mediastinitis. As soon as the open wound appeared, bright yellow pus began to rush out.
Chii Iik.
With good timing, Shim Yong-jun took the suction.
The pus that was drained with the suction machine reached a whopping 18 CC.
The fact that the patient survived until now without receiving any treatment seemed like a miracle.
While Shim Yong-jun was suctioning, Lee Hyeon removed a large area of necrotic tissue a little away from the mediastinum.
Empty!
Necrotic tissue fell to the curved surface.
“Please send it to the lab to be tested for bacteria.”
“I’ll send it right away.”
The circulating nurse left the rosette with the specimen, and Lee Hyun continued to insert the chest tube.
[Didn’t you study about esophageal perforation?]
As I barely managed to turn off the light, Choi Ki-seok’s words lingered in my head like an echo.
My two cheeks heated up.
It was a shame that even though I was in my first year of fellow training, I did not know how to properly perform an esophageal perforation. But he also had his own story.
This was because his advisor, Park Hyo-seong, did not properly teach him about the esophagus part.
The reason Park Hyo-seong postpones his education from day to day.
It was to take the lead in Park Hyo-seong’s relationship with him.
Originally, if the person below did a good job, the person above him would keep him in check, but in that context, Park Hyo-seong deliberately did not pass on his knowledge about the esophagus part.
You are still beneath me.
This is a signal to do well because there is still more to learn.
‘I should use this opportunity to learn properly.’
After completing the intubation, Lee Hyun’s gaze turned to Choi Ki-seok.
“Are you finished with the treatment?”
“Ah yes.”
“Then listen carefully while assisting.”
Choi Ki-seok continued speaking while using forceps to separate the esophagus and surrounding tissue.
“Esophageal perforation is generally most common in thoracic perforation. And in this case, empyema and sepsis were not commonly found in almost all cases. The key treatments include primary closure of the perforation, drainage, and treatment for sepsis. okay?”
“I’ll keep that in mind.”
Lee Hyun couldn’t help but be impressed as he answered.
Choi Ki-seok was in the process of sewing up the ruptured area with continuous sutures, and even while doing so, he was saying what he wanted to say.
Isn’t it difficult to suture even with your mouth closed?
However, the fact that he was suturing while explaining the process was proof that his suturing had reached a divine level.
“I will now tell you the suturing sequence. “You probably couldn’t see it properly because they were treating the mediastinum.”
“yes.”
“First, separate the esophageal muscle and surrounding muscles and suture the area where the esophageal perforation occurred. “Then, the separated esophageal muscle can be re-sewn with interrupted sutures.”
“All right.”
While we were talking, the primary anastomosis for esophageal perforation was completed.
I checked for leaks with a methylene solution, but there was no leakage.
Ki-Seok Choi’s stitching was perfect, as expected.
“Chief. Thank you for your effort.”
“Thank you for your effort.”
“You bastards. Are you drinking kimchi soup already?”
Choi Ki-seok burst into a wry smile at the staff’s greeting.
“Now that the esophageal anastomosis is done, isn’t the surgery over?”
“The patient also has damage to the stomach lining. “We need to treat the stomach too.”
“Isn’t that the responsibility of the gastrointestinal surgery department?”
Lee Hyun tilted his head and asked.
“If stomach damage is caused by esophageal perforation, it should be treated by a thoracic surgeon. Does Sewon Hospital call a gastrointestinal surgeon when performing gastroesophageal anastomosis on an esophageal cancer patient?”
“Oh no.”
“It’s right that we do what we can.”
While Choi Ki-seok was taking care of the rest, Rosette’s phone suddenly rang.
In response, Shim Yong-jun apologized, left the room, and answered the phone.
“This is Thoracic Surgery Rosette.”
“….”
“Ah. yes. All right. “Let me tell you something first.”
Shim Yong-jun, who returned, took advantage of Choi Ki-seok’s notice.
“That’s… the cardiology rosette. The patient reportedly encountered a problem during Percutaneous Coronary Intervention (PCI). So the manager asked if he could come.”
“Is hazing too much from the first day?”
Choi Ki-seok sighed and glanced at the staff.
“Hyun did the finishing touches. It won’t be difficult as all you have to do is close the surgical area. “I’m going to go to the internal medicine department.”
“yes. Thank you for your hard work.”
“I will finish it safely.”
“Believe.”
After receiving greetings from the staff, he put on his new clothes, finished scrubbing, and entered the cardiology room.
“Chief Choi is here.”
“You’re here.”
The internal medicine staff all focused on Choi Ki-seok.
“What happened?”
“that is. I was in the middle of a PCI…”
The briefing by surgeon Jaehyeon Yoon continued.
The patient was 60 years old and suffered from coronary artery stenosis. Since the patient desired PCI rather than CABG (coronary artery bypass grafting), he underwent PCI, which unclogs blood using a catheter.
The problem occurred during PCI.
Even though a balloon catheter was inserted, the blood vessel did not open.
Rather, his vitals continued to drop and an emergency situation occurred.
“There was absolutely no problem with PCI. “I don’t know why the patient ended up like this.”
“wait a minute.”
Ki-seok Choi looked at the chart and then used the eyes of Hippocrates toward the patient. Then, the diagnosis of acute dissection of the coronary artery and coronary artery thrombosis came to mind.
The internist who performed the surgery was caught in an unlucky case.
Even if there is no problem with the PCI, there are cases where emergency situations occur for unpredictable reasons.
“I think I need to switch to CABG. “For the current patient, there are limits to medical treatment.”
“All right. “I will personally obtain the consent form for the surgery.”
“I have one more thing to tell you. If possible, I would like to do MIDCAB…”
“MIDCAB?”
MIDCAB (Minimally Invasive Direct Coronary Bypass grafting) refers to minimally invasive coronary artery bypass grafting.
First of all, like OPCAB, it does not use a heart-lung machine.
The incision was small and the surgery was performed using a robot.
“Looking at the chart, the patient’s blood vessels were completely occluded and the lesion was excessively long. “I suffer from high blood pressure and diabetes.”
“That’s true, but…”
“MIDCAB is effective for patients with high surgical risk.”
“Hmm… I will take responsibility and persuade the guardian. First, let’s go to the patient and the C rosette. “There is a robot in the C rosette that can perform surgery.”
“thank you.”
Choi Ki-seok moved to C Rosette and began preparing for surgery.
Meanwhile, the warriors who had completed the esophagus perforation arrived at Rosette.
They clicked their tongues after hearing Choi Ki-seok’s briefing.
After barely completing the esophageal perforation surgery, I couldn’t help but feel embarrassed as MIDCAB assistance was discontinued…
“This is cute. “If you work with me, you’ll have to deal with even more severe cases than this in the future, right?”
“I once heard that the manager was a legendary fanta. “As expected, you are amazing.”
“I know.”
While I was talking with the staff, an internal medicine surgeon came into the room.
“The guardian agreed to MIDCAB. “I hope your surgery goes well.”
“Thank you for your hard work. “Leave the rest to me.”
Choi Ki-seok said hello to the internist and sat down at the console.
Passive Skill
NEW [Robotics Lv.3]
– When performing robot surgery, the ability to handle the robot and the robot kill speed increase by 1.5 times.
– As the level increases, abilities increase.
– The maximum level is level 3.
When I checked the status window, my hand holding the stick naturally gained strength.
There was no way this surgery would fail.
