Fifth Vital [EN]: Chapter 361

362. A Bomb About to Explode

“Alright! Let’s start the surgery. Everyone, please concentrate and follow along until the end.”

“Yes, Director.”

The surgery began, and with Taekyung’s words, he made an incision along the lesion he had marked beforehand.

These days, most hospitals use endoscopy for minimally invasive procedures. However, when a suspected lesion is this large, it’s necessary to make a larger incision to properly address the bone structure.

Of course, this places a tremendous burden on the patient. In fact, once the back is opened like this, the patient often struggles considerably after the surgery.

Taekyung made a long incision and used a Bovie [electrocautery device] to stop the bleeding. Then, he picked up a right-angled instrument.

It was about 25cm in total length, with sharp teeth at the end, designed to continuously widen the incision when inserted and pulled.

The back needs to be approached in a straight line along the bone as much as possible, so right-angled tools are used to continuously widen the area.

With a little more progress, the very back of the vertebra becomes visible. The back of the vertebra is similar to a triangular shape.

He cut through the muscle attachments with the Bovie, going deeper and deeper.

This process can also cause bleeding and requires a lot of strength as the area needs to be continuously widened. However, the most dangerous part is next.

A disc issue ultimately arises when the path of the spinal nerve is compressed in some way.

This can be due to the surrounding membrane hardening, pressure from an external source, or a disc protrusion.

The causes are various, but ultimately, reducing the pressure will lead to treatment.

Reducing the pressure involves carefully cutting into the bone near the spinal cord and addressing the surrounding membrane. This is a delicate and stressful process.

As Taekyung reached a certain depth, he saw the dura mater [the outermost, protective layer of the membrane surrounding the spinal cord] surrounding the spinal nerve.

Thump- thump- thump-

Here, affected by the cerebrospinal fluid, it appeared to be throbbing like a heartbeat.

“Doctor, seeing that makes me feel even more nervous.”

“Lee, you’ve been studying hard, I see.”

From the perspective of someone not performing the surgery, this sight would seem like a marvel of the human body. However, for Taekyung, who was performing the surgery, it felt like a bomb about to explode.

This is because even a slight injury here can lead to a major disaster.

The spinal cord is surrounded by a fluid with constant internal pressure, and if this pressure drops, the brain can literally collapse.

Then, the brain can descend within its cavity and touch the bone.

In this case, an unimaginable headache occurs, unlike any headache one experiences in life.

And what’s even more frightening is that there is no cure. If it doesn’t end there, the brain could protrude, leading to death.

Even if it doesn’t go that far, damage to the spinal cord can impair all functions below the injury.

This can result in loss of bowel and bladder control, as well as sensory and motor dysfunction in the lower extremities.

In Taekyung’s eyes, it was as if a heart was throbbing, and he was carefully manipulating the surrounding membrane.

It goes without saying that each touch must be made with considerable care for the patient.

“Kerrison bone punch [a specialized instrument designed to precisely remove bone without damaging underlying tissues; it resembles large scissors with a small, biting tip], please.”

Taekyung positioned the bottom of the bone punch so that it touched the top of the throbbing dura mater and carefully brought the instrument to the area to be removed.

He carefully manipulated the instrument to avoid removing more than expected.

These processes are not explicitly detailed in textbooks.

The ability to intuitively remove just the right amount without damaging the dura mater is purely a matter of experience and intuition.

In fact, most surgeries rely heavily on this type of skill. That’s why the experience and skill of the surgeon cannot be ignored.

“Doctor, it’s scary just watching this.”

Lee Chanhee swallowed hard.

“Of course. I feel the same way.”

“Are you scared too, Doctor?”

“Of course. Even a 0.5cm mistake here could paralyze this patient, so I have to be extra careful.”

Very slowly, but steadily, he was removing the hardened areas around the dura mater.

“That’s enough.”

After removing the desired amount of hardened tissue, the dura mater clearly had a gap, and the space had widened.

Then, he carefully examined the compression fractures, another reason for opening the area.

Without necessarily removing everything, he examined the boundaries and determined whether to drill holes and insert pins or use cement (for medical use) to reinforce the area.

“Hmm…”

After a close look, Taekyung made a decision.

“I won’t do anything.”

“Pardon me!?”

Lee Chanhee asked, seemingly puzzled by Taekyung’s decision.

“You’re not going to do anything? Why?”

“You see this here?”

“Yes, Doctor.”

“This happened a while ago.”

“A while ago?”

“Yeah. The bone has already fused, so this patient wouldn’t have been in pain because of this. It’s okay.”

After hearing Taekyung’s explanation, Lee Chanhee immediately understood the patient’s condition. However, there was one thing he didn’t understand.

Clearly, the current state of the spine didn’t seem to warrant the extreme pain the patient had been complaining about just before entering the operating room. It was ironic.

“Alright! Let’s close up.”

Taekyung continued, while Lee Chanhee was lost in thought.

“It’s important to carefully connect the back muscles and the upper part of the vertebrae one by one. Here and here.”

“Yes, Doctor.”

“This is Lee’s first time assisting with a back surgery, so just watch carefully for now.”

“Understood.”

Afterward, Taekyung carefully and meticulously sutured everything closed.

Compared to closing the abdomen, there were fewer steps, but in terms of delicacy, the current suturing was just as challenging.

Thus, the surgery, seemingly the 1137th but not quite, was completed with meticulous suturing.

“Doctor, you worked hard…”

“Lee?”

Taekyung called out his name, interrupting Lee Chanhee’s greeting.

“Why that expression?”

“Yeah. You’ve had a constipated puppy look since a while ago. Do you need to go to the bathroom?”

Anesthesiologist Lee Donghoon chimed in.

“…”

“What, is it serious?”

Taekyung asked, looking at Lee Chanhee, who was silently staring at the sutured area of the 1137th surgery, lost in thought.

“No, it’s just that I can’t understand it no matter how much I think about it.”

“What do you mean you can’t understand…”

“I was just wondering why this person was in so much pain when the bone has already fused like this.”

“Well, we’re doctors, so we examine and make judgments directly… The exact reason is often unknown. The pain a person feels isn’t objective; it’s subjective.”

“That’s true.”

Taekyung’s words were correct.

Even if the same area hurts, some people find it bearable, some say it hurts, and others complain of extreme pain.

“According to the correctional officer yesterday, he was severely beaten by his cellmates, so he might have felt the pain more intensely because of that.”

“Director, you’re right. It hurts to be hit by one person, so it would hurt even more if you were deliberately beaten by several people.”

“Well, I have a slightly different thought.”

Lee Donghoon shook his head briefly from side to side after hearing Nurse Lim Jeongsook’s words and pointed to the 1137th patient.

“Who is this patient? He’s an inmate in prison, right?”

“What does him being an inmate have to do with him being in pain?”

“It does. It definitely does. People who are in prison for a short time aren’t like this, but people who are serving long sentences like him are said to be itching for some fresh air. As the years go by and fewer people come to visit, people start to feel desperate.”

“So, you’re saying that after a long prison life, he’s itching to see the outside world, so he pretended to be in pain on purpose?”

“Hey, he was beaten by several people, so it wasn’t entirely on purpose. But he might have exaggerated the pain to some extent.”

“Then why would he specifically ask for surgery?”

“That’s obvious. He doesn’t want to go back to prison, so he’s trying to hold out as long as possible. It’s more comfortable in the hospital than going back and getting beaten again, right? Then, he’ll look for an opportunity to escape, like a bird longing for freedom…”

“So, you’re saying he might run away?”

“Right? That’s exactly it.”

Lee Donghoon reacted strongly to the words of the operating room staff and continued.

“You can’t tell just by looking at a person’s appearance, but look at this guy’s face. He looks extremely ordinary. Those are the scariest people.”

“Oh my! You’re writing a whole scenario. Our doctor watches too many movies and dramas. The correctional officer said yesterday that this patient is a model prisoner in prison.”

“I know, right? What kind of world is it these days where an inmate who came out for treatment would run away?”

“Really? Actually, I watched a prison movie a few days ago and it was really good.”

“Oh, that explains it. Thank you for the cinema talk, Dr. Lee Donghoon.”

“Everyone worked hard.”

“You too, Director.”

The slightly ironic surgery ended with Lee Donghoon’s enjoyable story, and Taekyung greeted the medical staff and went outside.

“Doctor, is the surgery over?”

As he went outside, the correctional officer who had been waiting in front of the door approached and asked.

“Yes, it’s over. The patient will be out soon.”

“If the surgery is over, can I put the handcuffs on his legs?”

“Ah, yes. That’s fine. And there was no need to touch the patient’s bones, so I just sutured it back up.”

“Yes, what do you mean by that…”

Taekyung explained the 1137th patient’s condition in detail to the correctional officer, who was puzzled.

“So, the pain was severe due to the assault, but there was no need for surgery.”

“Yes, that’s what I’m thinking right now.”

“That’s probably it. He was beaten brutally, so it makes sense that it hurts. Anyway, thank you for your concern.”

“You’re welcome. I’ll see you again.”

“Yes. Thank you for your hard work.”

As Taekyung left, the correctional officer immediately handcuffed the legs of the 1137th patient, who was lying on a bed, as he came out of the operating room with the medical staff.

Afterward, the 1137th patient was moved to the recovery room, woke up from anesthesia, and was taken to the ward after monitoring his progress.

Meanwhile, Taekyung also informed Lee Jiguk, the officer in charge of the correctional facility’s medical room, about the 1137th patient’s surgical progress and medical opinion.

The 1137th patient, who was still suffering from severe pain, would be monitored while receiving treatment for trauma and pain.

* * *

“Hey, what’s wrong?”

The 1137th patient, who had been explained about his spinal condition by Taekyung after being transferred from the operating room to the ward, suddenly became less talkative. The correctional officers asked him, noticing this.

“The director said it wasn’t serious, right?”

“That’s right. It’s a good thing you didn’t have spinal surgery. It takes a long time to recover, and it’s hard.”

“No. That’s not it… I’m saying this because I’m worried you two might misunderstand, but I really didn’t…”

The 1137th patient said with a rather serious expression, as if complaining.

“What do you mean suddenly by ‘misunderstand’ and ‘didn’t…’?”