Disaster (6)
The eyes of the staff, including Daniel Lee, turned to the surgical site.
The aorta is largely made up of three parts: the intima, the media, and the adventitia.
Aortic dissection means that the intima is torn and the blood inside it flows into the media, causing the media wall to be divided into inner and outer layers.
In the long silence, the first to take action was Haecheol Yang.
Cheeeeeeeek.
He sucked the blood with a suction device, and Daniel Lee, who came to his senses belatedly, clamped the upper part of the aorta where the dissection had occurred with vascular forceps.
Click!
As soon as the bleeding was stopped with vascular forceps, the amount of bleeding was noticeably reduced.
“Chief. What should we do now?”
[First, split the ascending aorta. That way, you can see the condition of the inner lining and medial lining.]
“I understand. “Meth.”
Daniel Lee held the scalpel given to him by the sterilizing nurse and applied it to the aorta.
The burden of knowing that the patient’s life depends on you.
The fear of making a mistake.
My hands couldn’t move as I wanted due to the two emotions, but I steeled myself and drew the scalpel.
Suuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu.
The blood vessel wall split open, revealing what was inside.
“Ah…”
The staff all sighed as if they had made a promise.
Is it because the patient was wandering from place to place without receiving proper treatment?
The condition was serious.
The intima was torn to a size more than twice that of a typical aortic dissection patient, and the size of the resulting false passage was significant.
It was a miracle that I survived until now.
[Wake! There is no time to zone out.]
“Yes!”
[Daniel and Hae-cheol close the falsetto, and Yong-jun and Jae-hyun remove the dissected aorta.]
“Are we going to do the treatment too?”
Shim Yongjun tilted his head and asked.
It was not common for the 3rd and 4th assistants to begin treatment at the same time as the surgeon.
[The four of us must move together to save even a little bit of time. Contact the station and ask them to send a few more disinfection nurses to help you guys.]
“I understand.”
Shim Yongjun left his seat and called the station using the phone next to the rosette.
Meanwhile, Lee Daniel and Yang Hae-cheol were closing their falsetto, one of the key treatment steps.
Let’s go together.
Daniel Lee tightens the suture needle with a needle holder and begins to sew up the hole in the aortic media.
The speed was slow, like suturing underwater, but I concentrated my mind and started suturing one stitch at a time. Yang Hae-cheol, on the other side, worked with Lee Daniel to hold the skin tissue and cut off the top of the completed knot.
‘If things continue like this…’
A faint smile appeared on Choi Ki-seok’s lips as he watched the residents through a video call.
The four of you were doing much better than I had feared.
Even though they were treating patients beyond their capabilities, they were not intimidated and were doing their best in their work.
Although the buffs that Ki-Seok Choi had gained so far were helping him greatly.
Empty!
The dissected aorta fell into the curved plate.
Jae-Hyeon Jo and Yong-Jun Shim, who completed their missions, assisted again, making the surgery somewhat faster and managing the patient’s vitals easier.
“Chief. “The false suture has been completed.”
[good job. From now on, the damaged aorta will be reconstructed with artificial blood vessels. Can you see the false anastomosis between the dissected part and the anastomosis?]
“Yes.”
[Just anastomose the border with an artificial blood vessel. It doesn’t matter if it’s a little slow, so be as careful as possible. If you do it wrong, you could end up dissecting the aorta with your own hands.]
“I’ll keep that in mind.”
[Woven Dacron, please.]
The disinfection nurse nodded at Choi Ki-seok’s words and brought in an artificial blood vessel suitable for artificial blood vessel replacement surgery. Then, Hae-cheol Yang placed an artificial blood vessel over the damaged aorta.
“Artificial blood vessel replacement surgery begins.”
The finale of the surgery came with Daniel Lee’s solemn words.
Geek. click. Geek. click.
Drurrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Bleep. Bleep.
The sound of a needle holder being tightened and the sound of scissors.
The sound of the heart-lung machine running and the mechanical sounds of the patient monitoring device filled the operating room.
At some point, the thoracic surgery residents stopped exchanging a word.
We were united as one and focused on saving the patient.
Thanks to the residents’ extraordinary efforts, the artificial blood vessel anastomosis was completed by nearly 40%.
Seven hours have already passed since the surgery.
Considering that aortic dissection surgery usually takes 8 to 10 hours, progress was slow. However, the fact that only residents came this far was enough to receive applause.
“Chief. “Is the patient you are keeping okay?”
[It’s breathtaking. I feel like I’m barely holding on with the new medication.]
“I see. “You’re going through a lot of hardships while stuck in the gastroenterology surgery department.”
[What is the hardship? For your information, a doctor’s work should not be confined to the narrow scope of patient care. Everything related to patients is a doctor’s job. In that sense, being in the digestive surgery department is definitely my job.]
“As expected, the director is different no matter what.”
[boy. Flattery…]
Choi Ki-seok was speechless.
There was embarrassment on the face visible through the phone.
At that moment, the patient monitoring device began to cry loudly, like a child begging for milk.
“What is it?”
Daniel Lee, who was in the middle of suturing, let go of the surgical tool and looked puzzled.
There were some minor mistakes, but in the grand scheme of things, the replacement surgery was proceeding without any problems.
Even after washing the eyes and examining the surgical area again, there were no problems.
So then, what is the problem?
[Rupture occurred in the aortic arch. Cover the wound with gauze and suction!]
As soon as Choi Ki-seok finished speaking, blood poured out from the aortic arch, the upper part of the aorta that is curved in the shape of a bow. As Yang Hae-cheol took prompt treatment, the amount of blood flowing into the aorta decreased.
“Chief. “What do I do now?”
[First, put on a blood pack and administer a hemostatic agent.]
Choi Ki-seok, who gave the order, watched the situation and sighed in despair.
I experienced a similar case at Uijin University.
At the time, the surgeon was Song Myeong-jin, and Choi Ki-seok was assisting with the surgery as an intern. The patient passed away due to a sudden rupture of the aortic arch.
There was no way the residents could resolve such a situation.
‘There is only one way.’
Choi Ki-seok checked the status window and used the good luck and bad luck item he received after treating a VIP patient during his time at Uijin University.
“The treatment you mentioned has been completed. What next…”
Daniel Lee’s eyes changed 180 degrees as he asked the question.
As if I had become a completely different person.
“Haechul. “You and Yongjun will have to have artificial blood vessel replacement surgery.”
“My me?”
“Why are you so surprised? “I heard that I also performed right atrium rupture surgery with Director Choi.”
“That’s right, but…”
“You can do it. “If you are.”
Daniel Lee’s gaze shifted to his classmate Jo Jae-hyeon.
“Jaehyun. You come up second. “Let’s do aortic arch surgery.”
“…okay.”
Jo Jae-hyeon, who had hesitated, nodded as if he had made up his mind.
Click.
A new treatment began when Daniel Lee clamped the upper part of the aortic arch.
“Meth.”
He cut off the dissection of the aortic arch with a scalpel given to him by a sterilizing nurse. And then they started suturing the area where the caustic occurred.
‘and. it’s crazy.’
Jo Jae-hyeon stuck out his tongue as he watched his classmate Daniel Lee being treated.
Despite the use of hemostat forceps, bleeding continued.
Even though Jo Jae-hyeon was using suction, the amount of suction could not keep up with the amount of bleeding, which resulted in poor surgical visibility.
Since the aortic arch is overflowing with blood, should we say this is natural?
Nevertheless, Daniel Lee was sewing his falsetto in a sea of blood.
It is like sewing places that cannot be seen with the naked eye, relying only on sense.
“What are you doing. “Cut it.”
“uh? uh.”
The false suture treatment was completed in the blink of an eye with Cho Jae-hyun cutting the knot.
The view of the aortic arch, which had been stained with blood, was clear as if the sutures had been properly sutured.
“You suddenly seem like a different person. “Are you Daniel?”
“maybe?”
Daniel Lee smiled and started the artificial blood vessel replacement surgery.
He finished the aortic arch replacement surgery like fried beans in a flash and took over the baton of aortic replacement surgery.
As a result, the surgery, which had been progressing slowly, quickly reached its final stage.
The aorta and aortic arch replacement surgery was completed in just one hour after Daniel Lee changed dramatically.
“Remove the clamp. “Please inject cardioprotective fluid.”
“yes.”
As the disinfection nurse injected cardioprotective fluid, Daniel Lee removed the vascular forceps that were blocking blood flow. As blood began to circulate in earnest, the aorta, which had been asleep, began to move with a gurgle.
“There is nothing wrong with my vitals. “I’ll raise your temperature again.”
Upon reporting to the anesthesiologist, the staff heaved a sigh of relief without worrying about who should go first.
finished.
Aortic dissection surgery and unexpected aortic arch dissection surgery.
These two problems were overcome solely through the power of the resident.
The light of accomplishment and emotion was clearly visible in the four people’s eyes toward each other.
“But Chief. “What happened?”
Shim Yong-jun started his luck.
“You know you’ve been totally cool since the aortic arch dissection showed up, right? “The orders were delivered quickly and the sealing speed was almost the same as Manager Choi’s.”
“that’s right. that’s right. Did I even believe my eyes? “I don’t know why I’ve been hiding my skills so far.”
“Well… well.”
Daniel Lee, with the venom drained from his eyes, avoided the gaze of his colleagues as if he were embarrassed.
Although he did perform the latter part of the surgery, it could also be said that he did not do it.
If anyone heard it, it might sound like a fart, but it was the truth.
At some point, he became an observer.
It felt as if Choi Ki-seok came into his body, spoke to him, and took care of him.
All he did was give in to the strange feeling.
[Everyone did well. If it became known that the residents had performed aortic surgery and aortic arch surgery, other hospitals would be upset, right?]
Bright smiles appeared on the staff members’ faces at the sound of Choi Ki-seok’s voice.
“The manager worked hard too.”
“It must be difficult to take care of a critically ill patient, so please watch over our surgery.”
[You guys added to the hardship.]
Amid a moment of silence, Daniel Lee opened his mouth.
“Chief Choi. I have a question.”
[What?]
“That’s… oh no.”
[It’s bland. I’ll give you a big treat as soon as you leave the ward, so look forward to it. Everyone go in and get a good rest.]
“Yes. Manager.”
“Thank you for your hard work.”
Daniel Lee took the lead, followed by the rest of the staff.
The surgery was completed successfully.
* * *
Choi Ki-seok hung up the phone and leaned against the back of his chair.
Watching the surgery via video call was close to hard labor. It was not easy to understand the surgical field of view and the image quality was poor, so I had to use my impressions the whole time.
‘Still, I’ve overcome one hurdle.’
A faint smile appeared on his lips.
In fact, my heart sank when a new dissection appeared in the aortic arch.
Because an ordeal has come that residents cannot handle.
If it weren’t for the good luck and bad fortune items obtained earlier, the patient might have died on the spot.
A good or bad fortune item.
This was an item that enabled remote control.
You could send your soul to another person, or conversely, you could bring another person’s soul into your body.
When I was training in the United States, there were many skilled surgeons around me, so I didn’t have to use it, but it was only today that it showed its shine.
‘Is it my turn now?’
Choi Ki-seok stood up and looked down at MERS patient Yang Jeong-hwan.
