Fifth Vital [EN]: Chapter 406

Kim Yeon-joo, meeting her daughter’s gaze, looked at her with a mix of emotions. She wanted to give her young daughter strength before she went into surgery.

“You know Mom, Dad, and Grandma love Jinie very much, right?”

“Yes, I know. I love you too.”

“Don’t worry about anything and just think of it as going to sleep and waking up. Jinie can do well, right?”

“Yes, I can do well. I’ll have the surgery and come back, so don’t cry, Mom, and stay with Dad. Okay?”

Children mature quickly when they are sick. Jinie, who was more mature than her peers, was more worried about her mom crying because of her than about going into surgery.

“Of course. Mom won’t cry.”

Kim Yeon-joo barely managed to hold back the tears that threatened to spill because of her daughter’s concern for her.

“Dad will be with Mom. Jinie, don’t worry about that.”

“Our daughter, fighting!”

“Fighting!”

The child clenched her small fist, mimicking her mother, and answered bravely. Meanwhile, a nurse approached to take her into the operating room.

“Jinie, hello.”

“Hello.”

“The doctor came to go into the room with Jinie. Shall we go inside?”

“Yes. Mom, Dad, I’ll be back.”

“Jinie, Mom and Dad will be here in front.”

“Have a good surgery, our daughter.”

“Yes, Mom, Dad.”

Lee Jae-san and Kim Yeon-joo waved to their daughter as she entered the operating room with the nurse.

“Excuse me, doctor…….”

As the door closed, Kim Yeon-joo called out to Tae-kyung with a look as if she was about to cry. Then, she clasped her hands together and spoke earnestly.

“I’m so sorry to ask this, but please, our daughter… please save our daughter Jinie.”

“We and the medical team will do our best.”

“Please, Director.”

“Then I’ll see you after the surgery.”

Clang-

Tae-kyung, after saying goodbye to the couple, went straight into the operating room.

“……Hic!”

As the door to the operating room, which she usually entered dozens of times, closed firmly, Kim Yeon-joo’s heart did not calm down.

Thinking of her young daughter undergoing surgery alone in that room, the tears she had barely held back finally flowed down her cheeks.

She felt as if her daughter was sick because of the adults’ selfishness, and she felt so heavy-hearted and upset that she couldn’t explain it in words.

Above all, Kim Yeon-joo felt like her heart was breaking when she heard from her husband the day before that her daughter’s illness was cancer.

Unlike her husband, who had somewhat expected it, she was quite shocked because she had not expected it to be that bad.

No matter how bad it was, she had never thought it would be cancer, so the shock was even greater.

Her heart ached at how difficult it must have been for her daughter during all those painful times.

“Sniff!”

“Why are you crying? Jinie went in for surgery to get better.”

“I feel like Jinie is like that because of us. I’m sorry…….”

“Yeon-joo, don’t think like that and let’s just pray that the surgery goes well.”

Lee Jae-san comforted and soothed his crying wife.

“Honey, the surgery will go well, right?”

“Of course. You were so brave in front of Jinie until just now, why are you being like this?”

“No, I’m just worried because they said it’s cancer…….”

“Don’t you remember what the director said yesterday? When he was persuading your mother, he said he could save her. I trust the director.”

“I trust him too.”

“Then. Let’s not think about anything else right now and just trust and pray to the director. Okay? You need to be strong.”

“That’s right. I need to be strong.”

Kim Yeon-joo, calming her troubled heart, clasped her hands together with her husband and prayed for the surgery to go well.

* * *

At the same time, Jinie, who had entered the operating room earlier, was comfortably asleep as a drug to induce sleep was injected into her arm through an IV [intravenous drip].

“Director has entered.”

“Was she okay when she got the shot?”

“Yes, she said she would bravely have the surgery with her mom, and she only frowned a little, but she got the shot well.”

“That’s a relief. Today’s surgery may be a little different from usual. It’s not as perfect as the operating room we usually use, but I believe everyone will do their best.”

“Yes, Director.”

“Please think carefully so that our movements don’t get tangled.”

“I understand.”

“First, the patient’s fasting time is not sufficient, so insert an L-tube [Levin tube, a nasogastric tube] to empty the stomach.”

“Yes, I understand.”

“And then immediately anesthetize her and lay her down with her left side up.”

The steps of Tae-kyung’s orders moved quickly and accurately.

“I’ll intubate and proceed with the anesthesia.”

Eui-jin, who had finished removing the food remaining in the stomach and proceeded with the anesthesia, continued.

“Director, where will you stand?”

“I’ll stand by the child’s back.”

“Yes. Anesthesia is complete.”

“Okay! Now let’s start the surgery. Everyone, concentrate and let’s finish well.”

“Yes, Director.”

As Tae-kyung announced the start of the surgery in earnest, the eyes of the medical staff in the room were full of fighting spirit.

Tae-kyung made a shallow incision below the ribs with a scalpel, and then deeply incised with a bovie (electrocautery) [a device using heat to cut tissue or stop bleeding], revealing the muscles.

Choi Mo-na used a retractor [a surgical instrument used to hold back tissues or organs] to pull back the muscles one by one.

Each time the muscle was cut with the bovie, the muscle twitched.

“Put a finger in a little.”

When Tae-kyung cut the last muscle layer, he put his finger in and pulled it out convexly, then put the bovie on the muscle above his finger and cut it.

The reason for this was to prevent damage to the organs.

“Okay…… Doctor Choi, fix it.”

“Yes, Doctor.”

At Tae-kyung’s words, Choi Mo-na took out the iron tools and fixed them to the operating table.

After cutting all the last muscles, an opaque, light blood-colored membrane was visible.

This membrane is the fascia [a layer of connective tissue], and the kidney is pulled so that only the fascia is cut without being injured.

From now on, it is the stage of tearing off the stubborn fat around the kidney. If you look at the fat, the expression ‘stubborn’ was really appropriate.

Using scissors or a bovie (electric scalpel) can damage the kidney, so rub the blunt side between them and insert it.

“We need to be careful in this part.”

“That’s right. We have to be careful.”

Tae-kyung moved with a very cautious touch.

The kidney is an organ, but it can be regarded as a mass of capillaries [tiny blood vessels]. Therefore, if it is injured, there may be excessive bleeding to the point where it is difficult to stop the bleeding.

Moreover, it is not possible to estimate how much body fluid the child currently has.

The reason why Tae-kyung was so concerned about blood pressure was that blood pressure could be a measure of the degree of bleeding.

In other words, it means that even a slight bleeding should be avoided.

Of course, even if there is no damage to the kidney, there will be slight bleeding while removing the membranes in between. Such bleeding can be stopped by cauterizing it with a bovie (electric scalpel).

“Shall we find the ureter now?”

Now it’s time to find the ureter [the tube that carries urine from the kidney to the bladder], which is the exclusive property of urologists.

This ureter is very troublesome if damaged. Obstetrics and gynecology and general surgery all pay a lot of attention to the possibility of damage to this ureter during surgery.

Therefore, Tae-kyung also tells them to find the ureter that goes from the kidney to the bladder well between the fats and keep it safe. It sounds like a joke, but the expression ‘keep it safe’ was just right.

If you tear off the fat and membrane, you will feel a sensation that is clearly different from other tissues in the lower part of the kidney.

It is difficult to clearly distinguish this with the color visible to the eye. Therefore, you have to touch and find each one well.

If you tear off the fat around it, the precious ureter appears, and to keep it safe, tie a knot with a thick thread and pull out the string.

‘It’s worse than before…….’

As he tried to take out the kidney, the fifth vital smell, which was stronger than when he made the incision, penetrated through the mask. Still, the third-stage fecal odor that filled the room was stronger than formalin [a solution of formaldehyde in water, used as a preservative], so there was no great inconvenience.

Of course, the formalin smell was also mixed in, and the fecal odor was so strong that it was pungent, but Tae-kyung, who had already developed immunity to the fifth vital smell, was unfazed.

Soon after, he pulled out the kidney to remove the cancer that had been afflicting the child.

Since all the membranes and fats have been removed, only the kidney remains intact.

Since the kidney is a mass of blood vessels, the bleeding when a part of the kidney is removed is no joke.

“Doctor Choi, how is it?”

“Anyone can see that it’s cancer.”

“Right?”

“Yes. Maybe it’s because it’s cancer, but it feels even worse.”

“That’s right. Me too.”

“Please take out the hemostatic gauze [gauze used to stop bleeding].”

“What should I give you?”

“Just give me what’s on the table now. Time is more important.”

Tae-kyung plans to apply hemostatic gauze that melts in our body to the cancer and the cut kidney section and then suture it, as he is concerned about bleeding from the kidney.

“It’s quite big.”

“I know. It’s bigger than I expected.”

Although it was a child, the size of the cancer was quite large. So it would have been visible from the outside.

I didn’t measure the exact size, but from what I can see now, it looked like it was three times the size of an adult’s fist.

Tae-kyung also thought about cutting and attaching each stitch one by one to minimize bleeding. However, he chose the method of cutting the cancer at once, blocking it with gauze, and quickly suturing it, as it could be difficult to suture completely.

“Okay! This is almost here. When I cut, spread these gauzes and fix them well on the cut kidney surface. Then I’ll quickly suture it sideways.”

“Yes! Doctor.”

Tae-kyung cut without hesitation but accurately.

Of course, the incision line has to go further towards the kidney for complete incision.

Choi Mo-na spread the gauze from the side and brought it over.

“Quickly!”

Now, Tae-kyung’s unique, consistent, and accurate suture began. This time, speed was important, but so was tension.

The reason is that it is suturing and hemostasis [stopping blood flow] at the same time.

The feeling at this time is different from when surgeons suture other organs.

It is really difficult to find out the subtle difference in suture and to have a sense that does not damage the parenchyma [the functional tissue of an organ] (the tissue cells that perform the actual function of the organ).

If it is weak, bleeding will occur, and if it is too strong, there may be damage to the surrounding area of the kidney, so you have to concentrate and do well purely in the area of ​​sensation.

The hemostatic gauze had already turned from white to black due to the blood seeping out.

“……!”

Choi Mo-na, who had been momentarily distracted by Tae-kyung’s perfect suture, was startled as if she had remembered something important.

“Doctor! The frozen biopsy [rapid tissue analysis during surgery] (emergency pathological examination during surgery to check for cancer cells on the cut surface) results have not come out yet.”

“Yeah. I know.”

“……Yes!?”

Choi Mo-na was slightly embarrassed by the calm answer as if nothing had happened.