Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 152

#152 Happy Birthday (11)

I frowned, examining the monitor.

‘It seems even lower than yesterday……?’

The oxygen saturation, a crucial vital sign, was alarmingly low.

Despite my best efforts to supply oxygen, it wouldn’t rise above 90.

Eisenmenger patients adapt to low oxygen levels and live with it their entire lives.

So, to increase oxygen transport, their bodies increase red blood cell production, much like people living in the oxygen-deprived heights of the Himalayas.

However, the more severe hypoxemia [low blood oxygen] that comes with pregnancy can be challenging even for Eisenmenger mothers who have adapted to it their whole lives.

Moreover, this hypoxemia not only affects the mother but also directly impacts the fetus.

That’s why we’re providing oxygen therapy for both the mother and the fetus, but the levels seemed too low right now.

‘This is serious… it seems much lower than I thought. Does the attending physician know about this?’

Just as I was about to move to ask the resident, Nurse No-eul began to cough deeply.

“Cough, cough.”

Beep, beep, beep—

At the same time, her oxygen saturation plummeted.

Nurse No-eul violently turned her head and spat out phlegm mixed with blood.

‘Hemoptysis! [coughing up blood]’

I urgently pressed the call button and shouted,

“Doctor, Jeong No-eul’s saturation is dropping to the 60s, and she’s experiencing hemoptysis!”

Thud, thud—

I could hear several people running from the station in the distance.

Meanwhile, Nurse No-eul, as if accustomed to it, wiped the blood from her mouth and took slow, deep breaths on her own.

“Hoo— Hoo—”

Gradually, her oxygen saturation began to rise.

Resident Doctor Yoo Jeong-nam, who rushed over in surprise, quickly assessed the patient’s condition.

Then, he handed her a nebulizer (Iloprost, an inhalation treatment for pulmonary hypertension) that was nearby.

“Sss—”

As Nurse No-eul put the device to her mouth and inhaled, her oxygen saturation very slowly returned to around 90, its original level.

“This patient might need to be monitored in the ICU (Intensive Care Unit)…….”

Doctor Yoo Jeong-nam muttered to himself in a low voice.

After a moment, Nurse No-eul, now calmed, said in a composed voice,

“…It feels like I’ve been having hemoptysis more often these days, Doctor.”

Doctor Yoo Jeong-nam nodded.

“Yes, that’s right. As the baby grows, it’s becoming increasingly difficult for both the mother and the baby.”

It was obvious.

At 32 weeks, the increased red blood cell count and the muscularized lungs of the Eisenmenger mother continued to produce hemoptysis.

“Doctor, setting me aside… it’s true that this is dangerous for my baby if we continue like this, right?”

“……”

Doctor Yoo Jeong-nam couldn’t answer easily.

He didn’t want to exacerbate the guilt of a mother who was already struggling.

But a doctor couldn’t lie, so he spoke in a gentle tone.

“…Yes, the baby is suffering just as much as you are right now.”

As the baby grew larger in the womb, more and more blood couldn’t pass through the lungs and was being wasted.

And as a result, the oxygen in the blood decreased.

Even at this moment, the fetus was exposed to hypoxemia before even seeing the light of the world.

This naturally had a negative impact on the fetus’s development.

Perhaps the fetus was saying in the womb,

‘Mom, is this world always this difficult……?’

But Doctor Yoo Jeong-nam put on a bright expression and said reassuringly,

“We have a meeting at 5 PM today, so I’ll let you know the results right away. For now, please rest comfortably in your bed.”

After saying that, he gestured to me.

I comforted Nurse No-eul and quickly followed him.

“Intern, you know about the conference at 5 PM, right?”

“Yes. Should we prepare in the Department of Internal Medicine 8 as usual?”

“Today, it will be held in the main conference room on the 3rd floor of the annex.”

“The main conference room?”

He nodded at my question.

“Professors from cardiology, thoracic surgery, anesthesiology, and pediatrics will all be there, not just our obstetrics and gynecology department. We’re going to have a discussion about Nurse Jeong No-eul’s future plans, so make sure to prepare enough chairs.”

My eyes widened.

How many departments are gathering?

A conference of this scale was rare.

Indeed, managing an Eisenmenger mother and leading her to a healthy delivery was no ordinary task.

Still, with the most renowned professors from Yeon Guk University Hospital gathering, I had hope that they would come up with a solution.

“I want two interns to go and prepare 30 minutes beforehand.”

“Yes!”

I nodded and quickly moved.

Suddenly, a tagline from a science fiction movie I had seen before came to mind.

We will find a way. We always have.

* * *

Click—

I flipped the switch.

Soon, the bright white fluorescent lights flickered on in sequence, illuminating the large conference room.

Screech—

I arranged the desks and filled the chairs.

Meanwhile, Nurse Mi-seon turned on the projector and lowered the screen.

It was a task that interns always did, but today it was a larger conference room than usual.

“Seon-ah, how many people did they say were coming?”

“Well, shouldn’t we assume that at least 20 people will come?”

“Wow, we’re talking about one patient… this is the first time I’ve been to a conference meeting with so many departments.”

Soon, people from various departments gathered in one space.

In superhero movies, there are scenes where characters arriving from different places make a grand entrance at headquarters.

It was no different now.

At the request of the obstetrics and gynecology department, several heroes began to gather as if summoned.

The first hero.

.

They are in charge of managing the pulmonary hypertension [high blood pressure in the lungs] that Eisenmenger patients have.

They adjust various medications to match the physiological changes that occur during pregnancy.

The second hero.

.

The patient currently has a congenital heart defect.

Originally, it was a disease that should have been surgically corrected by thoracic surgery in childhood.

Thoracic surgery calls these adult congenital heart disease patients GUCH (Grown-Up Congenital Heart disease) patients and manages them specially with cardiology.

The third hero.

.

The fetus, currently being managed by obstetrics and gynecology, will be managed by pediatrics immediately after birth.

The professor in charge of the neonatal intensive care unit (NICU) made a direct appearance.

The fourth hero.

.

It is the most important department in childbirth.

Once Nurse Jeong No-eul’s delivery begins, they will be responsible for her vital signs. After anesthesia for childbirth, monitoring and medication adjustments are the responsibility of anesthesiology.

And finally, the department, which is currently responsible for the patient.

In total, five departments gathered in one place to combine their strengths.

I felt a slight flutter in my heart.

Even when I watched a five-part combining robot on TV as a child, it wasn’t as impressive as this.

“Shall we begin?”

As everyone sat down, the professor of obstetrics and gynecology started the meeting.

Nurse Mi-seon and I sat on makeshift chairs at the very back.

Professors from each department were seated at the ‘ㄷ’-shaped table, and I could see the faces of residents I knew here and there among the chairs arranged in the back.

In the distance, I could see Kim Viper from internal medicine.

Song Yoo-joo, the thoracic surgeon sitting across from me, glanced at me and then turned her gaze back to the screen.

“As you all know… Patient Jeong No-eul, who came from Changyang University Hospital, is in very poor condition.”

No further explanation was needed.

Perhaps because they had already exchanged a lot of consultations through the EMR [Electronic Medical Record], they all seemed to be aware of the patient’s condition.

“The patient is now entering her 32nd week.”

Whoosh—

A chart with the patient’s vital signs was displayed on the screen.

The professor of obstetrics and gynecology continued.

“Since the 32nd week is when the hemodynamic burden [the heart’s effort to pump blood] peaks, her hemoptysis is also getting worse.”

“Wow, saturation of 63? Even with oxygen support like that?”

A voice that cut in with a chatty tone in the middle of the obstetrics and gynecology professor’s words was familiar.

Professor Heo Joon-im.

She was the grateful professor who defended me during the disciplinary committee for the Gangnam Station incident.

The professor of obstetrics and gynecology replied.

“Once she starts having hemoptysis, it drops like that. Right now, she’s getting about 90 saturation with high flow oxygen.”

Then, Professor Heo Joon-im sighed.

“Oh my, this is a disaster… I heard that she’s already on the maximum dose of pulmonary HTN medication. She needs to be in the ICU.”

As the topic of ‘pulmonary hypertension’ came up, the professor of cardiology immediately took the floor.

“The patient’s RL shunt (right-to-left shunt) is increasing, and heart failure is progressing……”

A briefing on the patient’s hemodynamic status followed.

“Anyway, she’s barely holding on with medication, but I don’t think she can hold on any longer. It seems like we need to deliver the baby.”

In other words, the cardiology department’s argument was.

We need to get the baby out quickly.

Everyone seemed to agree with this direction without any disagreement.

Soon, a question followed from the cardiology side.

“How is the fetus’s condition?”

“The fetus’s estimated weight is in the lower 13th percentile, and the abdominal circumference (an important factor in assessing fetal growth) is below the lower 5th percentile. Betamethasone (a drug that helps the fetus’s lung maturation) is being administered, but we can no longer leave the fetus in this hypoxemic state.”

The obstetrics and gynecology department’s answer was.

The fetus is already growing slowly and is not doing well. Anyway, we need to get it out quickly.

Then, it was the pediatrics professor’s turn to speak.

“That’s right. At 32 weeks, our NICU (Neonatal Intensive Care Unit) can fully care for the baby, so if you just set the delivery date, we will attend and immediately take the baby to the incubator and transfer it to the NICU.”

The pediatrics department’s opinion was.

Trust me and get it out!

It was as if they were saying that as long as they could safely get the baby out, the pediatrics department would somehow manage.

The feeling of reassurance from the pediatrics professor’s words was fleeting.

The real problem began now.

So, how should we get it out?

“I think it would be best to do a C-section (cesarean section) under general anesthesia. What do you think, anesthesiology professor?”

Then, the anesthesiology professor, who had been quietly silent since earlier, opened his mouth carefully with his chin resting on his hand.

“Well, if SVR (systemic vascular resistance) drops during general anesthesia, it could also be a problem… but I still think general anesthesia would be better.”

The anesthesiology department is responsible for the patient’s life during the surgery.

Therefore, the anesthesiology department’s opinion is very important.

Everyone pricked up their ears at his words.

“Pulmonary artery pressure monitoring will definitely be necessary. New anesthetics have been developed these days, so childbirth itself isn’t as risky as it used to be. But…….”

The professor’s brow furrowed.

“…I’m worried about bleeding or something during the C-section delivery. I’m worried about whether the patient’s current heart and lungs can adapt if the hemodynamics change. The heart and lungs are already close to their limit.”

Can the mother survive the surgery?

Who could answer this difficult question?

All the professors closed their mouths as if they had made a promise, and a slight silence flowed.

Everyone seemed to be deep in thought.

‘It’s not an easy problem for the professors either.’

I swallowed hard and focused on the conversation.

If the professors at Yeon Guk University Hospital were this cautious, it wouldn’t be easy no matter which hospital in the world you went to.

At that time, someone spoke up.

“Oh, so about that. We are currently considering one method.”

One method?

I looked up.

Everyone was looking at thoracic surgeon Heo Joon-im, who had made the sound.

It was time for one of the most important words in this conference room to come out.