Fifth Vital [EN]: Chapter 79

Fifth Vital- Episode 79 (79/502)

79. Impulsive Behavior

Zhiing-

With Lee Chan-hee’s mental state stabilized, Tae-kyung finally entered the operating room.

“Give me a gown.”

Tae-kyung naturally dried his hands, donned the gown, and then pulled on surgical gloves.

‘Ugh! The smell.’

The familiar Fifth Vital smell felt more pungent today. In particular, the faint sulfur smell that lingered like a shadow irritated him.

‘I really need an air purifier today.’

Distracted by the smell, Tae-kyung headed to the table where countless surgical instruments were laid out. He picked up cotton balls soaked in povidone [an antiseptic solution] and a ring forcep and approached the patient’s neck.

Since it was thyroid surgery, the patient was under general anesthesia and positioned with a cushion under their shoulders, head tilted far back.

Tae-kyung generously applied povidone from the patient’s jawline to above the chest and to the ends of both shoulders. Very meticulously and carefully.

‘He’s applying more than usual today.’

Nurse Lim Jung-sook and Doctor Eui-jin each thought to themselves as they watched.

‘It must be a dangerous surgery, so he’s using a lot of povidone.’

It was one of Tae-kyung’s habits. The more tense and dangerous the surgery, the more povidone he applied.

He wasn’t aware of it, but the medical staff in the operating room noticed the stark difference and were all aware of it.

Eventually, Tae-kyung poured the remaining povidone onto Lee Go-cheol’s neck.

“Okay, drape, please.”

“Yes, Doctor.”

As Tae-kyung covered the patient with the surgical drape, the medical staff began to move busily.

Drrr-

The steel table with surgical instruments lined up was pushed right next to the patient. And the tools to be handed to Tae-kyung immediately were arranged separately on a larger table.

After that, the first assistant, Lee Chan-hee, organized the Bovie (electrocautery device) and suction lines.

“Pen, please.”

Tae-kyung, who was staring at the patient’s neck as if trying to visualize the surgery, reached back and said.

“Here it is.”

Tae-kyung, holding the sterilized pen, carefully touched the patient’s neck.

‘This side, and this side.’

Then, he drew the anatomically important structures one by one, starting with the Adam’s apple and below.

Ssuk- Ssuk-

It looked like he was sketching, but that wasn’t the case.

He was marking the locations he needed to remember during the surgery.

“Dr. Lee, what am I marking right now?”

“Sternocleidomastoid muscle [SCM].”

“That’s right. I’m marking the SCM.”

The SCM is a muscle that extends diagonally from just below the ear to the end of the clavicle below the Adam’s apple, and lymph nodes are arranged around it.

“These lymph nodes are the main enemy we’ll be dealing with today. Remember it well.”

“Yes, I will.”

“It’s not a one- or two-hour surgery, so it’ll take a while. Everyone, please stay focused until the end and do your best.”

“Yes.”

“Understood.”

“Although it’s a familiar operating room for us, it’s a place the patient didn’t want to come to. Let’s not be complacent and do it without regrets so they don’t have to come back.”

Tae-kyung looked at all the medical staff except himself in turn and steeled his resolve.

“Scalpel, please. Dr. Jung will begin the surgery.”

“Yes, Doctor.”

Tae-kyung, holding the scalpel, made a 5cm horizontal incision about 3cm below the Adam’s apple.

“Bovie and tooth (small forceps with teeth-like grips at the end).”

“I’ll also take tooth and Debakey forceps (forceps with long, thin ends).”

As Tae-kyung grabbed one side of the incision, Lee Chan-hee grabbed the other side and lifted it. Soon after, Tae-kyung, holding the Bovie, spread the tissue under the skin, and Lee Chan-hee silently sucked up the smoke from the burned tissue with the suction.

“Allison (forceps with wide ends), please.”

Tae-kyung, receiving the Allison, grabbed the incision closer to the patient among the cut incisions. He gathered the tissues under the skin, grabbed them together, and pushed them back, and Lee Chan-hee immediately reached out and pulled them toward the patient’s head.

Tak-

In the meantime, Tae-kyung reached out and adjusted the lighting. He peeled off the patient’s skin and tissues by pressing them with the blunt end of the Bovie, and cauterized and pushed back the parts where the tissues were too strongly attached.

He repeated this process on the lower incision of the patient. Then, fascia and muscles with blood vessels in places were visible.

“Dr. Lee, what do you think of when you see these blood vessels?”

“They look like vines.”

“That’s right.”

Lee Chan-hee’s answer was correct.

The blood vessels here were spreading like vines climbing a wall. He carefully worked between them to prevent bleeding.

Tae-kyung incised the platysma muscle (a muscle like a curtain on the front of the neck) extending from the jaw down with the Bovie, including it with the Debakey forceps. The thyroid gland is right below these muscles, so the muscles must be incised little by little with caution.

“Army navy retractors (instruments used to retract tissues, etc., with the ends bent in a ㄱ shape), please. One more, please.”

Tae-kyung, receiving the instruments, hooked the ends of the instruments on the top and bottom of the vertically cut muscles, and Lee Chan-hee widened the muscles this way and that while pulling one side of the instrument to secure the field of vision.

“This is the thyroid.”

“…….”

“Dr. Lee?”

Tae-kyung touched the thyroid with his finger, fixed his gaze, and said again.

“Lee Chan-hee!”

When there was no answer, a loud voice echoed in the operating room.

“Ah, yes. Yes, Doctor.”

“You don’t mean…… spacing out again?”

“No, no.”

Lee Chan-hee, who understood Tae-kyung’s unspoken concern, showed strong denial.

“That’s absolutely not the case.”

“Are you sure?”

In the middle of the surgery, Tae-kyung deliberately asked Lee Chan-hee questions. There was also the purpose of teaching, but there was also the intention of relieving tension and fear. But when Lee Chan-hee didn’t answer, he shouted, thinking that he might collapse again in this short moment.

“I’m sure. I was so focused on your skills that I didn’t hear you calling me.”

It was true.

When you watch Tae-kyung’s surgery, you can’t help but focus on his skills and become engrossed. Especially, it even evoked the illusion that he had eyes on the ends of both hands.

“Honestly, when I see your surgery, I can’t help but focus.”

“Tell me honestly. Were you dozing off?”

“Pardon? I didn’t doze off. And it’s true.”

“Our Dr. Lee is always watching you intently, Doctor.”

“Indeed. Nurse Lim is the only one who understands my heart.”

“Quiet. There are two important things in thyroid surgery. One is that it’s difficult to distinguish between lymph nodes and parathyroid glands, so you have to distinguish them well and save the parathyroid glands.”

“But the patient’s cancer has spread a lot.”

“That’s right. Lee Go-cheol is an exception. It’s spread so much that we have to remove everything, so we’ll just cut out anything suspicious.”

With his hands and eyes still fixed on the patient, Tae-kyung was only moving his mouth.

“And there’s one more important thing. What is it?”

“It is not to damage the nerve running around the thyroid gland.”

“Yes, that’s right. Probably around here…… Allison, please.”

Tae-kyung grabbed the upper part of the thyroid gland with the Allison forceps and pulled the right thyroid gland to the left, and Lee Chan-hee received the instrument. Then, the lower part of the right thyroid gland began to be visible.

“It seems to be around here. First, we dig in one by one, but we have to be careful when digging around here. Can you see this nerve here?”

“Yes, Doctor.”

“This nerve affects the voice, and the stem that controls the muscles around the neck is also near here, so we have to be careful. Okay! Harmonic scalpel, please.”

Now, to separate the thyroid gland, he incises the many blood vessels and muscles connected to it one by one.

“We always have to be careful of bleeding with these tissues.”

“Yes.”

All of these tissues can cause bleeding, so ligation (a technique to block the ends of blood vessels or nerves) must be performed to prevent bleeding in any way.

Ddi-ddi-ddi-ddi-

As the ultrasonic cutting began, a constant mechanical sound echoed in the operating room.

“When this machine came out, me and the other residents cheered.”

“Why?”

“When this wasn’t available, we had to tie all those structures one by one.”

“Back then, the doctors really struggled to tie in the operating room.”

Nurse Lim Jung-sook, who was next to him, added a word.

“It must have been difficult.”

“That’s right. If it was a thyroid surgery, you had to do it more than 100 times.”

Tae-kyung, who was talking about the past, picked up the harmonic scalpel and put it down again.

“Gemini hemostatic forcep (scissors-shaped forceps bent at a 90-degree angle, making it easy to dig into the area to be ligated, such as blood vessels and muscles), please.”

Dugun-dugun-

Tae-kyung pushed the Gemini under the blood vessel that was beating like a heart. Then, he repeatedly widened and inserted the instrument so that the Gemini pierced under the blood vessel.

Dugun-dugun-

The blood vessel was still jumping up and down on the instrument in time with the heartbeat.

“Tie.”

At that word, the nurse handed Tae-kyung a melting thread at the end of the mosquito (a small scissors-shaped clamp with a slightly bent end).

Tae-kyung carefully brought the end of the mosquito to the end of the Gemini instrument. Then, after the end of the thread touched the end of the Gemini, Lee Chan-hee used the Gemini to grab the thread, and when he pulled the Gemini, the thread came out under the blood vessel.

Because the blood vessel is blocked by tying with this thread, Tae-kyung naturally performed a surgical tie.

One of the things that defines a surgeon’s skill is their tying technique.

‘Yes, this is the feeling.’

He could feel the texture of the thread against his finger.

It was a skill that anyone would recognize the moment they saw it, but Tae-kyung still never forgot to practice tying before important surgeries.

Because there is such a thing as a feel for it. Especially when tying blood vessels, that feel is very important.

If the pulling force is too strong, the blood vessel will tear, and the surgical site will be filled with blood in an instant.

Tae-kyung tied the blood vessel completely by applying force precisely where he needed to, without pulling the thread too much. And this mastery was immediately apparent to any experienced doctor.

‘The control of strength is really amazing.’

Eui-jin and Lee Chan-hee each admired inwardly as they watched the process.

‘How can he tie like that against a pulsating blood vessel?’

The balance of accurate force was being achieved in Tae-kyung’s hands, applying pressure on the blood vessels as naturally as flowing water.

‘He practiced for exactly two hours yesterday.’

Lee Chan-hee, who was admiring the quick and accurate tie, suddenly remembered what Nurse Lim Jung-sook had said earlier.

‘You don’t mean tying practice?’

‘Yes, he ordered this and that from the delivery company and tied knots without moving.’

After hearing the story of Tae-kyung still practicing tying, he realized once again that the skill in front of him was not created automatically.

“Harmonic scalpel.”

Tae-kyung tied it and cut the blood vessel right below it with the harmonic scalpel.

“Gemini.”

Again, he dissected and ligated the surrounding finely connected muscles one by one using Gemini.

‘I expected it, but the shape is very distorted.’

The appearance of the thyroid gland, which had been distorted by cancer, began to be revealed, and Tae-kyung pushed the thyroid gland to the left again.

“This is the recurrent laryngeal nerve (controls the larynx that makes the voice) that I mentioned earlier. We have to push this aside and prevent it from getting hurt.”

“Yes, Doctor.”

Tae-kyung dissected all of the lower part of the thyroid gland, dissected the part in contact with the trachea with the harmonic scalpel, and ligated the area where the trachea and thyroid gland were attached using a tie.

“It doesn’t seem to have invaded the trachea yet, but I’m not sure. I’ll send the frozen biopsy (a method of quickly freezing and examining the area incised during surgery to check for cancer by a pathologist through a microscope) all at once after the other side is done.”

“Yes.”

“And please send the area in contact with the trachea that just went out as a trachea margin for frozen biopsy.”

“Yes, Doctor, I understand.”

“Okay! Now, let’s start with the left side, which is the normal thyroid gland.”

The part with cancer is difficult because there are many adhesions around it, but the normal part is less so. Therefore, the dissection and incision were completed quickly in about 1/3 of the time compared to the right side.

“Whoa!”

Lee Chan-hee finally breathed a sigh of relief after dissecting all the thyroid glands.

As the tension he had been holding on to was slightly relieved, he let out a short sigh of relief into the mask. But Tae-kyung was different.

Tuk-tuk-

Suddenly, he took a step back from the surgical position and turned around to walk towards the patient’s feet.

Tuk-tuk- tuk-

‘What’s wrong?’

‘Why is he doing that?’

‘Huh? What is it?’

It was right then, when the staff were wondering about Tae-kyung’s actions.

Jjwaak-

A ridiculous thing happened before their eyes.