Disaster (5)
Gastroenterology surgical ward lounge.
Choi Ki-seok was watching the news while wearing a mask.
As the number of MERS patients increased and deaths occurred, all news was focused on MERS. To exaggerate the current situation, it would not be strange to say that it is at the level of a national disaster.
‘Still…’
I drank the coffee on the table and stood in front of the window.
With the eyes of Hippocrates, MERS patients were discovered early and successfully isolated.
Thanks to this, we were able to prevent additional MERS patients from occurring at Sewon Hospital.
At least until now, ten days after the ward was closed.
Make sure you have enough for one more week.
After that time, Sewon Hospital was able to escape the risk of MERS infection.
Isn’t the incubation period for MERS up to two weeks?
Since the incubation period was safely spent with the ward closed, it could be assumed that there was no chance of contracting MERS due to problems with the hospital itself.
Knock. Knock. Knock.
As soon as the knocking stopped, a nurse came inside.
“Chief Choi! Patient Yang Jeong-hwan….”
“Let’s go together.”
Choi Ki-seok hurriedly moved to the isolation room where Yang Jeong-hwan was.
Easy profit.
After putting on the costume, going through the air shower, and entering the isolation room, I saw Yang Jeong-hwan looking haggard.
Yang Jeong-hwan is the first MERS patient at Sewon Hospital.
Until I was quarantined, I was only complaining of cold-like symptoms, but two days ago, the situation changed 180 degrees.
He showed symptoms of acute pneumonia and renal failure, his body temperature approached 39 degrees, and he suffered from severe breathing difficulties.
Currently, medical treatment using intravenous fluids and drugs is being carried out.
A perfect treatment for MERS has not yet been developed.
“The patient’s temperature rose again. Even though 100 percent oxygen is administered, breathing seems difficult. What should I do?”
The nurse looked at the patient with a worried expression and then stared at Choi Ki-seok again. However, even Tribble Board thoracic surgeon Choi Ki-seok could not give a sharp answer.
If a blood vessel is torn, it can be replaced with an artificial blood vessel.
If a tumor develops, the tumor can be removed.
The surgical style is to jump directly into the diseased area and fix it.
However, the MERS patient did not have any obvious lesions that required surgery. It was not possible to use methods such as cutting out or replacing the part of the lung that was immediately problematic.
“Wait.”
Choi Ki-seok made a call to someone using the cell phone he kept in his sanitary bag.
“It’s a snowflake.”
[huh. Ki-seok. Are you feeling okay?]
Jeong Seol-hwa, who answered the phone just a second after connecting, asked in a voice full of worry. Choi Ki-seok, the person in charge of this incident, was living in isolation from other staff at the gastroenterology surgery unit where the MERS patient occurred.
Jeong Seol-hwa’s concern about this was special.
“Then who am I? “You returned safely after being kidnapped by a terrorist group in Sudan.”
[fool. Are you bragging?]
“I’m sorry. “I was trying to reassure you.”
[no. Sorry for being sensitive. All you have to do is stay healthy. Are you calling because of a patient?]
“Uh. “I need your help again honey.”
Ki-Seok Choi relayed the patient’s symptoms and test results explained by the nurse to Seol-Hwa Jeong.
After hearing his story, Jeong Seol-hwa did not respond for a long time.
Even as an internist, it seemed difficult to come up with a clear solution to MERS.
[It hasn’t been verified, but the use of Intergeron and Lavarin together is becoming established as the established theory for treating MERS?]
“I heard that too. “They are both treatments for hepatitis C, right?”
[huh. Intergeron is excellent for immune management, and Lavarin is an antiviral drug. The problem is that patient Yang Jeong-hwan is already receiving that treatment.]
“That’s why I called. “I couldn’t solve it with my abilities.”
[Honey is a surgeon. There is no need to be an all-rounder.]
Jeong Seol-hwa comforted him affectionately and continued.
[In an overseas paper, there was information that Lopinar was helpful in treating MERS. How about using Lopinar?]
“Are you serious?”
Choi Ki-seok raised his voice without realizing it.
Lopinar was a type of AIDS treatment that was used extensively in Sudan.
[Lopinard is also an antiviral drug. It might be effective if you adjust the amount and use it with Labalin.]
“Okay. “Honey, I’ll do as you say.”
[It may be difficult, but just suffer a little more and come out quickly. I will love you a lot.]
“Yes. “I will do as you command.”
The call ended with a joking remark.
After giving instructions to the nurse to prescribe Lopinar, Choi Ki-seok sat in the treatment chair and looked down at the patient.
A total of four patients have died from MERS so far.
What they had in common was that most of them were over 50 years old and suffered from chronic diseases. One unfortunate thing is that Yang Jeong-hwan meets all the conditions.
Twenty minutes later.
Ki-seok Choi stared at the patient monitoring device with a nervous expression.
The body temperature dropped somewhat, but the ventilator’s Fi02 (inspirated oxygen concentration) was below 150 and respiratory acidosis occurred. Functions related to breathing were seriously declining.
‘Is there any way?’
He thought and thought again.
Although it had been a while since the medication given by Jeong Seol-hwa was administered, the patient’s condition was deteriorating rapidly to the point where it was difficult to rely solely on the medication. At this rate, it wouldn’t be surprising if Yang Jeong-hwan stopped breathing at any time.
Jiyiing.
The call phone I kept in my gown trembled.
Choi Ki-seok bit his lip after checking the number.
It didn’t feel good.
* * *
Sewon Hospital Emergency Room.
Daniel Lee looked down at the patient lying on the bed and tried to hide his expression as much as possible.
I couldn’t believe it.
To make matters worse, I wondered why this happened.
“teacher. “What will happen to my father?”
The guardian grabbed Daniel Lee’s arm.
The moment Daniel Lee made eye contact with his guardian, he wanted to hide in a mouse hole.
“Could you please wait a moment?”
He left the place and called Choi Ki-seok.
[Daniel, is something wrong?]
“Yes. Manager. “A patient just came in and I don’t know what to do.”
[Why are you doing that?]
“Well… a patient with an aortic dissection came in, but there is no one who can operate on it right now. The professors left work early, and when I called the cardiac surgery fellow, he said he had gone home to Busan…” [
Can’t everyone be sent?]
“He has already visited several other hospitals, so his condition is very serious. “If we send everyone in, I think he’ll die in the ambulance.”
Daniel Lee paused before continuing.
“I’m really sorry, but would you mind if the chief took charge of the surgery?”
[no. I am also keeping a severely ill MERS patient (a doctor’s job of monitoring the patient’s condition). And it’s difficult to move around while the ward is closed.]
“I know that, but… I can’t think of any other way.”
Aortic dissection is a very urgent disease, and if it is not treated quickly, the patient will die. In general, surgical treatment is the rule, and the difficulty level of surgery is on the difficult side.
It was absurd to think that the problem could be resolved only with residents.
[They say it doesn’t work with internal medicine?]
“Yes. I contacted the cardiologist on duty and he said surgery would be better. “It’s because of ascending aortic dissection.”
[I can’t help it. Set up an operating room and prepare for surgery.]
“Is the manager coming?”
Daniel Lee’s voice became brighter at Choi Ki-seok’s answer.
If he operates on a patient, there is no need to worry about anything.
[What are you talking about. I can’t go. You guys do the surgery.]
“Are you saying that residents should perform surgery on aortic dissection among themselves?”
[There is no other way. There’s no time to talk, so call me back as soon as the surgery preparations are over.]
“Ah… I understand.”
Daniel Lee hung up the call and looked down at his phone with a devastated face.
The biggest crisis of a resident’s life has come.
As the most senior resident and chief, it was obvious that he would become a surgeon.
It was also very clear who would be responsible if a patient died during surgery.
“Oh. I don’t know!”
Daniel Lee called all the residents he could call to the operating room. After receiving consent for surgery from the guardian, the patient went up to the operating room.
First, there were a total of 4 residents waiting for surgery.
Shim Yong-jun and Yang Hae-cheol, second-year residents and youngest members.
Jae-Hyeon Cho, 3rd year resident.
There were three people like this.
“Chief. Are we really performing aortic dissection surgery on our own?”
Shim Yongjun, who heard the situation in advance, asked with surprised rabbit eyes.
“Don’t complain, it’s the manager’s instructions. wait for a sec.”
Daniel Lee called Choi Ki-seok as mentioned earlier. After finishing the call with him, I handed the phone over to the disinfection nurse.
“teacher. I’m sorry, but please connect via video call and film us performing the surgery. “Director Choi said he would give surgery orders remotely.”
“All right.”
The disinfectant nurse readily answered.
“ruler. Let’s scrub and get into the rosette.”
At Daniel Lee’s words, the staff stood side by side and scrubbed their hands and forearms with a brush dipped in disinfectant solution.
‘Anyway, he’s a great person.’
Daniel Lee was amazed and amazed by Choi Ki-seok’s wit.
Performing aortic dissection surgery with a staff comprised only of residents was extremely reckless. But Choi Ki-seok added one trick.
The plan was to intervene in the surgery using video calls.
As a result, Daniel Lee was able to ease the burden on his mind.
Jiyiing.
The rosette door opened and the staff began preparing for the surgery.
The process of connecting the time-out patient monitor, general anesthesia, preparing the heart-lung machine, etc. continued in an instant.
“Chief. Shall we begin?”
Daniel Lee’s eyes turned to the cell phone held by the disinfection nurse.
[Let’s change seats before that. Daniel continues as the surgeon, and only the positions of the second and third assistants are changed.]
“Wouldn’t Jaehyun be better as the second assistant? “It’s my third year.”
Daniel Lee tilted his head at Choi Ki-seok’s instructions.
[Haechul is better at emergency surgery. This guy has a very big liver. Jaehyun, don’t feel too sad. I’m not doubting your skills.]
“I’m fine.”
3rd year student Cho Jae-hyun sighs in relief when his seat changes.
Daniel Lee, seeing this, was surprised once again.
Because Choi Ki-seok accurately understood the characteristics of the residents.
“Then we will now begin surgery for acute Stanford type A aortic dissection.”
At his words, Shim Yong-jun disinfected the patient’s chest widely and covered it with a cloth.
Followed by median sternotomy.
The scalpel cut into the patient’s solar plexus and chest, and with a snapping sound, the sternum was split in half. When a retractor was installed in place and spread to the left and right, a wide surgical field of view was opened.
“Let’s connect a heart-lung machine.”
“yes.”
Staff inserted cannulae into the femoral artery and the right atrium, respectively.
Drurrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
While the heart-lung machine was running, the anesthesiologist placed the patient in a state of ultra-hypothermia for surgery.
[Is everyone ready?]
“Yes!”
[You can do it because I’m with you. Don’t be scared.]
With Choi Ki-seok’s spirit, the curtain rose on the aortic dissection surgery performed only by residents.
