Fifth Vital [EN]: Chapter 220

The Fifth Vital Sign – Episode 220

220. A Cold Corpse

“I feel so refreshed, maybe because I got a good shot…!”

Tae-kyung’s expression, as he walked and talked with Lee Chan-hee, instantly crumpled.

‘What is this smell…?’

The closer they got to the emergency room, the stronger the smell became, almost numbing his nose.

It smelled like a corpse rotting and burning, with a hint of sulfur.

Tae-kyung, frowning at the various odors, was searching for the source when it happened.

“Dr. Kim? Dr. Kim Tae-kyung?”

Just as he turned towards the smell, Oh Jae-bal from bed number 3 recognized Tae-kyung and greeted him with joy.

“Do you remember me? I’m Oh Jae-bal, the rice cake shop owner who had surgery for a work injury three years ago.”

“Oh! Of course. Hello. Long time no see…”

Tae-kyung, mid-greeting, stopped again. The fifth vital sign [an assessment of pain level], accompanied by the terrible stench, was the cause.

‘This is serious.’

He felt it. Oh Jae-bal needed immediate treatment.

“What do this patient’s lab results look like?”

“Yes?”

Lee Chan-hee answered nervously, noticing Tae-kyung’s rapidly narrowing brow and increasingly raised voice.

“The results haven’t come out yet.”

“How long has the patient been here?”

“Well, that’s… about one or two hours…”

“Dr. Lee, tell me exactly.”

“It’s been a little over three hours, I think.”

“Hey! Are you crazy, you son of a bitch?”

“Yes!?”

“…!”

Everyone present was surprised by the unexpected curse.

Lee Chan-hee was especially shocked because Tae-kyung never used profanity, no matter how angry he was.

“Run a full lab panel on Oh Jae-bal right now! Quickly!”

“Yes, I understand.”

“Patient, you said you feel weak, but what other symptoms do you have?”

Lee Chan-hee, in a panic, left his spot, and Tae-kyung calmed his voice as if nothing had happened and examined Oh Jae-bal.

“Oh, Doctor, I came all the way here on the train to see you today. Seeing you like this makes me feel like I have more energy.”

“Yes, I’m glad to see you too, patient. But what about your stomach? Does your stomach hurt? Do you feel feverish?”

“No. I just feel like my energy is draining away.”

It was true. His mouth and eyes were happy to see Tae-kyung, but Oh Jae-bal seemed to be struggling as his energy gradually faded.

“Doctor, the lab results are here.”

Lee Chan-hee, who had rushed over, said cautiously, looking around.

“WBC [white blood cell count, indicating infection]: 46000, CRP [C-reactive protein, indicating inflammation]: 20.7, and…”

“What are you doing! Dr. Lee Chan-hee! You’re a doctor, aren’t you? I told you earlier that the most important thing you should have learned during your residency is not to miss a dying patient… How could you leave a patient like this for three hours? It’s obviously sepsis! The patient is dying! Even the blood pressure is abnormal, what’s wrong with you? Get a grip!”

“I’m sorry, Doctor. I’m really sorry. I’ll prioritize…”

“Administer norepinephrine [a vasoconstrictor to raise blood pressure] to the patient, and among the restricted antibiotics [powerful antibiotics requiring special permission due to resistance concerns], do we have a prepped dose ready right now?”

“Yes, Doctor. We have meropenem [a broad-spectrum antibiotic effective against many infections].”

“Give that to him right away. But of course, before you give it, send out two sets of blood cultures immediately! Quickly!”

Tae-kyung’s urgent shout echoed through the emergency room.

Only then did the staff realize the seriousness of the situation and quickly gathered around Oh Jae-bal.

Nearly 10 medical staff members began to quickly carry out their respective tasks around the patient’s bed.

“Um, Dr. Lee? What should the dosage be for the vasoconstrictor and antibiotic?”

The nurse asked Lee Chan-hee cautiously.

“The patient weighs 60kg, so let’s start with 30 micrograms.”

“Give them both at MAX. Both at MAX.”

Tae-kyung gave the order without turning his head, his eyes fixed on the monitor showing the patient’s condition.

“Doctor, wouldn’t excessive constriction of peripheral blood vessels prevent blood supply to the extremities, and wouldn’t the antibiotic accelerate kidney toxicity, leading to kidney failure [loss of kidney function due to damage]?”

“Dr. Lee! It’s sepsis… This patient has sepsis!”

Tae-kyung’s voice, which had calmed down again, rose another level.

“Even if we pour in that much medication, it’s a matter of whether he’ll live or not. It’s a good deal if we save him and have to amputate his limbs.”

It was the first time he had spoken so bluntly about a patient. But that’s how serious Oh Jae-bal’s condition was.

“We might lose the kidneys. We have to save him first. Look at the patient’s blood pressure. The patient is going to die like this! Tonight! Do you understand what I’m saying now?”

Beep- Beep- Beep- Beep- Beep- Tick-

As if to prove Tae-kyung’s shout, the sound started ringing from the monitor next to Oh Jae-bal.

Beep- Beep- Beep-

The alarm of the emergency room machine spread, and many people turned their attention to the monitor showing the patient’s condition.

The patient’s respiratory waveform on the monitor was very irregular, and the respiratory rate was more than twice the normal level.

“The patient is crashing! Give him oxygen. Lee Chan-hee, do an ABGA [arterial blood gas analysis]. Prepare for intubation.”

“Yes, Doctor.”

“Give me an ambu bag [a manual resuscitator]. Turn on the oxygen. Turn it on full blast. There! Be careful not to step on the line!”

“Yes, I understand.”

Tae-kyung was sharper and more nervous than ever.

It was felt not only by the staff gathered around the patient but also by all the medical staff in the emergency room.

He was completely different from his usual self, as if he were a different person.

But no one thought that this appearance was because Tae-kyung’s personality was bad. Rather, it was a natural appearance as a doctor.

Because right now, at this very moment, Tae-kyung’s decision would determine whether Oh Jae-bal would become a cold corpse in ten minutes.

Life, no matter how low its value is set, is another universe.

No life is not precious. That’s why we must save it.

“ABGA results are in. Body pH: 7.1, blood oxygen saturation 80, blood carbon dioxide 56, bicarbonate [a buffer that regulates acidity, HCO3-] is 6.”

“Give him bicarbonate. The patient’s acidity is too high. We can’t keep this up. Give it to him right away.”

“Yes.”

The nurse next to him listened to Tae-kyung’s words, lengthened the line to give it like an IV fluid into the patient’s vein, and was about to connect it to Oh Jae-bal’s arm. But suddenly, Tae-kyung approached and snatched the work the nurse was doing.

“Oh!”

The nurse was surprised by the sudden action and stepped back slightly.

Tae-kyung didn’t care and transferred the contents of the IV bag into a 50cc syringe and pushed it directly into the patient’s blood vessel.

“Redo the arterial blood analysis in thirty minutes. Prepare the intubation supplies. Now! Hurry up.”

“Here, it is.”

The intubation tool, shaped like a crescent moon, was placed in Tae-kyung’s hand.

“Patient? If we do the procedure now, you’ll be surprised and move, so I’ll put you to sleep a little. Give him sleep anesthesia.”

As the drug entered, the patient’s eyes slowly closed and his limbs lost strength.

Then, after confirming that the patient had fallen asleep, Tae-kyung tilted his head back to open his mouth.

Now, he had to put the long, curved tool into the patient’s mouth, push the tongue aside, and guide it to the entrance of the airway.

After that, he had to lift the epiglottis [a flap protecting the airway] that covers the airway entrance.

Tae-kyung was standing at the patient’s head, bending over, stretching his neck, and looking into the patient’s mouth.

Looking at the dark inside of his mouth with the light coming from the intubation tool, he carefully lifted the epiglottis with the end of it.

Now, when the cover is opened, all he had to do was put the tube into the airway.

Tae-kyung and all the medical staff who rushed to save a person looked very urgent, like soldiers fighting a war.

“Give me the tube.”

Nurse Lim Jeong-sook handed the tube to Tae-kyung’s right hand, and he tried to push the tube in while looking around.

But at that moment,

Gluck- Gluck-

“Ptooey!”

Blood spurted from Oh Jae-bal’s mouth, splattering all over Tae-kyung’s face.

The moment he lifted it with the patient’s epiglottis, a handful of blood came up from the esophagus just below the airway.

“……!”

Even Tae-kyung couldn’t help but be nervous at this moment.

If the airway is blocked by blood or a similar situation, the patient will die immediately.

‘Please!’

Secretly cheering for the patient, Tae-kyung briefly straightened his back with a blood-stained face.

Beep- Beep- Beep- Beep-

“The patient’s oxygen saturation is dropping. 85, 82, 80, 79. It keeps dropping.”

Hearing those words, Lee Chan-hee snatched the ambu bag that the nurse was holding and covered the patient’s mouth.

“Doctor, I’ll supply oxygen first.”

“Yes, good job.”

“Oxygen saturation is rising again. It’s currently 85. Now it’s 90, 95.”

“Give it to me again.”

Tae-kyung bent over and said again. Then, he put the instrument in his left hand back into the patient’s mouth and lifted the root of the patient’s epiglottis with all his might.

Then, the airway entrance was slightly visible at the end of the light.

“Quickly! Quickly!”

Tae-kyung, who received the tube, pushes the tube in quickly and carefully.

“Okay! Connect the ventilator [a machine that helps the patient breathe].”

Lee Chan-hee, who was next to him, took out the stethoscope he was wearing around his neck and auscultated both sides of the patient’s chest.

“Intubation confirmed. Thank you for your hard work.”

“Yes, I think I’ve had a hard time this time. Chan-hee?”

“Yes, Doctor.”

“Was I too angry?”

“Ah, no.”

Lee Chan-hee knew Tae-kyung’s heart, and Tae-kyung also knew that his junior didn’t do it on purpose.

Doctors are also human, so not everything can be perfect. They had no choice but to continue to break, learn, and supplement their shortcomings through experience and grow further.

Therefore, Lee Chan-hee was not embarrassed or upset at all by Tae-kyung’s scolding. Rather, he was disappointed in himself for not noticing the patient’s urgent situation because he was busy.

“Forget what I was angry about earlier, and let’s save the patient first.”

“Yes. I’m really sorry.”

“Arterial blood gas analysis again, and what about the patient’s antibiotics?”

“I have already administered the antibiotics you mentioned, and I have done the bacterial culture and arterial blood gas analysis just now.”

Nurse Lim Jeong-sook answered, looking at Tae-kyung with a more energetic voice than usual.

She didn’t say it outright, but her eyes were full of encouragement and a will to save the patient, with a silent look that she was doing well now, so cheer up.

“The immediate crisis is over, so I’ll order a CT scan. Tell them to do it right away as an emergency.”

“Yes, I will proceed.”

If intubation is not performed, the patient will die within 5 minutes.

In fact, it is a skill that is not difficult, but if blood or food comes out like the patient now, even great people will have no choice but to turn white.

That’s natural, no matter how many critically ill patients you see.

“Ha! It’s hot.”

When Tae-kyung took off his doctor’s gown, the top he was wearing inside was soaked with sweat. It was a sight that showed how focused he was on saving the patient.

“Dr. Lee, squeeze the ambu bag while taking the CT scan, and contact me immediately if anything happens.”

“Yes, I understand.”

30 minutes later-

“Doctor, the results are out.”

The CT results were out.

Tae-kyung, who was sitting at the station monitor and repeatedly looking at the CT images up and down, crossed his arms as if frustrated.

“Is Oh Jae-bal’s patient’s bowel perforated?”

Lee Chan-hee, who was watching the monitor with him, asked.

“No. The CT scan is normal.”

“Yes?”

“There is no problem with the intestines being punctured or pus accumulating anywhere.”

“Then what’s wrong…….”