Fifth Vital [EN]: Chapter 45

45. Majang-dong Sack [Majang-dong is a district in Seoul known for its meat markets. A “sack” in this context likely refers to a specific technique or method related to surgery, possibly involving the containment or manipulation of tissue.]

The operating room was occupied by Dr. Euijin, Dr. Mona Choi, who arrived as an assistant after being contacted, and the nurses.

As Dr. Taekyung entered with his hand raised, the nurses helped him put on a surgical gown and sterile gloves.

“Patient!”

“Yes…”

Choi Seonhae replied weakly with an apologetic expression, perhaps because of her earlier actions.

“As I explained earlier, we will approach through the anus to stop the bleeding and suture [stitch the wound].”

“Ah, yes…”

“Even after this, you will need another surgery to create a stoma [an opening in the abdomen to divert waste], but this is an emergency, so we will focus on stopping the bleeding first.”

“I understand.”

“And if you disobey us again and eat food, I won’t operate on you. Understand?”

“Yes. I will make sure that doesn’t happen.”

Dr. Taekyung spoke in a stern tone, intending to scare her, but it was a white lie. If it made her listen, he was willing to lie for the patient’s sake.

“Dr. Jung, shall we begin?”

“Yes, Doctor.”

Dr. Euijin approached Choi Seonhae, who was lying down with electrocardiogram, blood pressure monitor, and oxygen saturation monitor attached.

“We will now administer anesthesia. Please turn to your side for a moment.”

As Choi Seonhae turned to her side, the nurse helped her get into the anesthesia position, slightly arching her back.

“Now, we will perform spinal anesthesia.”

“Doctor, will it hurt a lot? This is my first time having surgery.”

“No. It will only feel like a prick, so don’t worry. I will administer it carefully.”

“Yes, thank you.”

Dr. Euijin palpated [examined by touch] the area where he would inject the anesthesia and carefully disinfected it.

“Needle, please.”

Then, he skillfully inserted a long, thin needle between the arachnoid membranes [membranes surrounding the spinal cord] surrounding the spinal cord.

“Okay! Patient, you will feel a prick. Are you okay?”

“Yes, it doesn’t hurt at all.”

“Now, you will feel a warm sensation rising from your toes. This is a normal effect of the anesthesia, so don’t be alarmed.”

Dr. Euijin took an alcohol swab and approached the patient, rubbing her abdomen.

“Patient, do you feel a cold sensation?”

“No.”

Then, he rubbed the alcohol swab near her navel and continued to ask as he rubbed near her chest.

“How about here?”

“It’s cold.”

“Doctor, she’s anesthetized.”

Dr. Euijin, having confirmed that Choi Seonhae’s legs were completely anesthetized, said to Dr. Taekyung.

“Good work. Let’s start the surgery.”

“Excuse me… Doctor?”

It was then, after the anesthesia was complete and the surgery was about to begin, that Choi Seonhae called out to Dr. Taekyung in a hurried voice.

“Yes, patient, what is it?”

“I’m not sure, but if the anesthesia is only for my lower body, does that mean I’ll be awake during the surgery?”

“Yes, because it’s not general anesthesia, the surgery will proceed with you fully conscious.”

“I’m really sorry, but could you please put me to sleep?”

Choi Seonhae, who had calmly received the anesthesia, couldn’t bear the anxiety as the surgery was about to begin. It was her first time having surgery, she was scared, and her heart felt like it would burst when she thought of her daughter.

She just wanted to have the surgery comfortably and without any thoughts.

“I’m begging you.”

“Patient, if it’s the sound of the surgery that bothers you, we can play music in your ears.”

Nurse Lim Jeongsook, who was next to her, asked, trying to reassure the patient.

“No. I would like to have twilight sedation [a state of relaxed consciousness induced by medication].”

Since spinal anesthesia leaves the patient fully conscious, they inevitably hear all the sounds of the surgery, which is something they don’t want. In such cases, after carefully checking the patient’s condition, a small amount of twilight sedation is sometimes administered to reduce the psychological burden caused by the surgery.

“I’m actually very scared. I want to have the surgery comfortably.”

“I understand. We will do that for you.”

Dr. Taekyung considered Choi Seonhae’s opinion and safely administered twilight sedation. Then, the surgery began in earnest.

“Let’s start the surgery.”

First, he placed the patient’s legs up and secured them to the leg supports in the lithotomy position (similar to a pregnant woman giving birth).

Then, Dr. Taekyung sat on a low, round chair between the patient’s legs to see the anus. He covered the patient’s surroundings with sterile surgical drapes and also covered the area around the anus with sterile surgical drapes to prevent contamination during the surgery.

“Anal dilator!”

Dr. Taekyung, receiving a transparent, long, cylindrical plastic instrument, touched the gauze inserted into the patient’s anus with his other hand. And the moment he removed the gauze,

*Poosh*-

The pooled blood gushed out. As the gushing blood splattered on his surgical gown and face, Nurse Lim Jeongsook quickly wiped the blood off his face.

“Suction.”

“Yes, Doctor.”

Dr. Taekyung, who didn’t flinch even as blood splattered on his face, gave instructions in a calm tone.

“Yes, Doctor.”

Dr. Mona Choi, sitting side by side looking at the anus, quickly performed suction according to the instructions.

“One more time.”

“Yes.”

After the suction, Dr. Taekyung widened the anus with the anal dilator. However, the widened passage made it impossible to see the affected area due to the blood gushing out.

“Give me the suction.”

Dr. Taekyung quickly snatched the suction from Dr. Mona Choi’s hand. Instead, Dr. Mona Choi grabbed the dilator from Dr. Taekyung’s hand.

“Up!”

“Yes, Doctor.”

“Dr. Choi, that’s not it.”

“I’m sorry.”

“Lift it up to make it visible!”

“Yes, I understand.”

The sensitive and sharp voice came out through the mask in succession.

‘He’s a completely different person when he’s like that.’

Dr. Euijin muttered to himself, watching Dr. Taekyung’s heightened sensitivity.

‘Come to think of it, it’s Dr. Choi’s first surgery with senior, so she must be nervous.’

Unlike his usual kind personality, there were times when sharp charisma erupted like lava, and that was right now, when the patient was in critical condition.

“Dr. Choi, don’t lower your hand.”

“I will keep that in mind.”

A sharp voice cut through the tension that filled the operating room once again. Of course, Dr. Taekyung didn’t do it on purpose. He had to stop the patient’s bleeding, so in this situation, the surgeon couldn’t help but be sensitive.

‘It’s narrow. It’s so narrow.’

Moreover, the anus is narrow no matter how much it is widened. In addition, this was an emergency situation where the affected area had to be sutured accurately, making each suture difficult.

“Needle, please.”

“Which one would you like?”

“Give me a large nylon one. Load it on the needle used to close the abdomen.”

“Yes.”

*Clatter*-

It was then, as Nurse Lim Jeongsook was handing over the suture loaded on the needle holder (an instrument shaped like scissors with a blunt, long end to hold the needle).

“Ah! I’m sorry.”

Dr. Mona Choi accidentally touched the floor with the end of the instrument while quickly performing suction for visibility.

“Choi Mona! Can’t you be careful?”

“I’m sorry. I will do it properly.”

In fact, the surgery they were performing was an approach through the anus, so it couldn’t be completely sterile like other surgeries. The surgical site was inevitably contaminated by bacteria from the stool and rectum. However, there was no need to deliberately cause contamination.

Also, dropping an instrument during surgery is always a big mistake, so you must always be careful.

“If I can just get this part right…”

Dr. Taekyung 힘들게 [with difficulty] pushed the needle into the rectum with difficulty. And after making one suture, he performed a tie (a surgical knot to prevent the suture from unraveling), which he had done thousands of times.

“Suction one more time.”

After making the suture as tightly as possible, the amount of bleeding decreased significantly after suction.

‘Good. The bleeding will stop if I do it a few more times.’

Dr. Taekyung said to himself, trusting the sensation in his fingertips and concentrating on the suture. Dr. Euijin, Lim Jeongsook, and Choi Mona all remained silent during the difficult suture, focusing together on the fingertips guiding the needle.

And so, the arduous and difficult suture continued. It was only five sutures, but it took an hour.

“Finishing up.”

Normally, it wouldn’t take more than 5 minutes, but it took time to suture the narrow area while adjusting the appropriate depth in the right place.

“It’s all done now!”

“It’s not easy to have a suture as thrilling as today’s,” Nurse Lim Jeongsook said cheerfully, looking at Dr. Taekyung, who had finally relaxed his focused brow.

“That’s right. Now, I’ll disinfect with povidone [an antiseptic solution] and apply pressure with hemostatic gauze [gauze that promotes blood clotting].”

“Yes, Doctor.”

“And since the bleeding has stopped for now, let’s correct the blood levels and think about the next steps. Dr. Jung, have the patient’s post-operative tests come back?”

“Yes, they’re not normal, but they’ve improved a lot since earlier. I think they’ll gradually return to normal.”

“That’s a relief.”

Looking at the operating room clock, quite a bit of time had already passed.

‘It’s already dawn.’

Dr. Taekyung 괜스레 [for no particular reason] took a deep breath.

‘To be glad to smell this. Seriously.’

He could tell that the formalin smell that had been emanating from Choi Seonhae had changed. It was the first time he was glad to smell a faint fecal odor.

‘Today is a bit tough.’

Dr. Taekyung finally felt the tension release and fatigue washed over him. Still, he was in a good mood because the patient had overcome the emergency situation well.

“The patient is dehydrated due to the surgery, so give plasma solution 500ml bolus (administered without speed control) [a rapid, concentrated dose].”

Dr. Taekyung, getting up from his seat, rattled off orders for the patient.

“And what is Choi Seonhae’s weight?”

“65kg.”

“For the rest, give NaK1 10DW (10% glucose and sodium, potassium mixed solution) at 90cc/hr. I’ll adjust the speed based on the urine output in between.”

“Yes, Doctor.”

“I’ll prescribe the antibiotic piperacillin tazobactam, so please administer it according to the time and dosage.”

“Yes.”

“Lastly, please have the patient do some lung exercises starting tomorrow.”

“Understood.”

“Everyone, thank you for your hard work.”

“Thank you for your hard work.”

Dr. Taekyung, greeting his colleagues who had worked hard together, approached the face of the patient who had awakened from twilight sedation.

“Patient?”

“…Huh?”

“Choi Seonhae, are you coming to?”

“Ah, yes. Doctor, is the surgery over?”

“Yes, the surgery is over. We stopped the bleeding. We’ll watch you in the recovery room for a bit, but don’t lift your head because of the spinal anesthesia.”

“Yes, I understand. Doctor, thank you so much.”

“Our patient also worked hard.”

Without a trace of the scolding he had given before the surgery, Dr. Taekyung encouraged the patient with a warm demeanor and left the operating room.

* * *

“…Did it go well?”

Lee Chanhee, entering the medical office, said as he walked towards Choi Mona.

“Dr. Choi? Choi Mona! What are you staring at blankly?”

“I’m not deaf. And put it down.”

“What was that just now?”

Choi Mona, who hadn’t responded even when called, reacted immediately when Lee Chanhee picked up the giant jelly.

“You’re looking at me so fiercely just because I ate one little jelly. That’s disappointing between friends.”

“There’s only one king. The little ones eat it. Just one.”

“Anyway, did the surgery go well?”

Lee Chanhee asked, chewing on a gummy worm. He asked casually, but he was actually a little envious. A penetrating abdominal injury was not an easy case to come across.

“Judging by the nuance, it seems like you wanted to go in.”

“Isn’t that obvious? If I hadn’t been with a patient in the emergency room when the call came, I would have gone in.”

“That’s not true. Even if Dr. Lee hadn’t been seeing a patient, would you really have been able to go in?”

“Hey!”

Lee Chanhee shut his mouth at the unexpected fact bomb. It was annoying, but it was true. He had assisted with the pregnant woman’s surgery before, but he wasn’t sure if he could have done a good job assisting with this one if he had gone in recklessly.

‘What’s with Choi Mona being right?’

Lee Chanhee knew that he still had a long way to go, even though he had improved a lot since his initial training with Dr. Taekyung.

“That’s right. Dr. Choi, it was your first surgery with Dr. Kim. Don’t you feel something?”

“I don’t know.”

“Why not? Doesn’t your heart pound and make you think, ‘Wow, I want to be like that too,’ with a definite motivation as a doctor and a desperate thought?”

Lee Chanhee, who was a Dr. Taekyung 바라기 [a person who is completely devoted to or looks up to someone], poured out words non-stop as if he had a motor in his mouth.

“He uses both hands like a monster, and his hand movements are different. I got goosebumps when I first saw him suture.”

Choi Mona had been listening without much reaction, but she was also quite shocked. The reason she had made a mistake in the operating room earlier and the reason she had been spacing out a little while ago were all because of Dr. Taekyung’s surgical skills. It was also the first time she had thought that the ties he made during the surgery were beautiful.

‘How can he handle both hands so skillfully?’

Especially in a case like today, the suture itself was a difficult surgery. However, the suture he performed with both hands, evenly and without an inch of error, was truly an art.

‘What kind of doctor is a good surgeon?’

Then, an old memory suddenly came to mind. She remembered what the professor who had received the question during the first class at medical school had said.

‘Professor. Is the surgery of a truly good surgeon different?’

‘A truly good surgeon’s surgery has a certain air to it, even if you bring an ordinary person into the operating room to watch. You can’t help but acknowledge it the moment you see it.’

At the time, she thought the professor was just telling the students to work hard. That was even more so because she had never seen such a person before.

‘The person the professor was talking about really existed.’

Choi Mona couldn’t help but admit that Dr. Taekyung was that person.

‘Is it innate? Well, he has more than one board certification, so…’

While still ignoring Lee Chanhee’s words and thinking to herself, there was a question that she heard clearly in Choi Mona’s ear.

“Are you curious?”

“…”

“I know how Dr. Taekyung does that.”

“You know? It sounds like you have some kind of secret.”

“It’s a secret. Because I asked him directly a long time ago.”

Come to think of it, she remembered Lee Chanhee chattering about how he had been in the same hospital as Dr. Taekyung.

“What’s the secret?”

“You pretended not to be, but you were curious?”