Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 186

“What’s wrong, getting cold feet? Having second thoughts now that you’re actually going to saw through someone’s bone?”

Ma Dongseop grinned, revealing his teeth.

…As always, his expression combined with his words is terrifying.

“Do you think it would be okay for me to do it?”

“You have to learn how to do a sternotomy [surgical procedure involving a midline incision through the sternum or breastbone] during your first year anyway. It’s not like you’ve officially started your first year, but I’ll make an exception and let you do it! I’ll be watching you from behind, so don’t worry, hehe.”

Ma Dongseop looked excited as he said that.

It’s the same expression he had when he taught me how to insert a chest tube last time.

It seems he really enjoys teaching me things.

“The patient tomorrow won’t be getting a minimal incision; we’re going to do a full median sternotomy, so it’s a great opportunity for you!”

Ma Dongseop is right.

Tomorrow’s first surgery is a classic coronary artery bypass graft [CABG, a surgical procedure to improve blood flow to the heart] with a full incision.

It’s a good case for a beginner like me to learn and perform a sternotomy.

Ma Dongseop had taken me to the operating room several times before to show me the sternotomy process in detail.

“Well, you can quit if you’re scared. I’m not going to force you to do something you don’t want to do…”

“I want to do it!”

“I knew you’d say that.”

Ma Dongseop grinned at my enthusiastic response.

Since it’s something I have to do anyway, the sooner I learn, the better.

If Dr. Ma Dongseop hadn’t suggested it, I might have begged him to let me do it first.

‘Because I need to move on to the next stage as quickly as possible.’

Now, I need to move beyond being “Intern Shinseon” and become “Thoracic Surgeon Shinseon.”

I decided to gladly accept the high-speed training that Ma Dongseop was offering.

A new challenge is always a pleasure.

“By the way, what kind of patient are you talking about for tomorrow’s surgery?”

“Shall we look at the chart together?”

Click.

Ma Dongseop pulled up the chart on the monitor.

Soon, both of our gazes were focused on one place.

Kim Deoksang
M/49
DM (+)
Stable angina with LM, 3VD
Current smoker, 30PY
Father’s history of MI

“Ah, this patient… the one transferred from Sejin Hospital, right? I put in the orders earlier.”

I immediately recognized the patient’s diagnosis.

Unlike my early days as an inexperienced intern, I’m now used to looking at patient charts.

“Stable angina with LM, 3VD… Angina… meaning the major branches of the coronary artery are narrowed?”

“That’s right. You’ll be seeing countless patients like this in the coronary department from now on.”

Ma Dongseop displayed the patient’s CAG (coronary angiography) [an X-ray test to visualize the heart’s blood vessels] images on the adjacent monitor and asked me questions and explained various things.

Coronary artery.

The origin of the name is quite interesting.

The blood vessel’s shape resembles an upside-down king’s crown, hence the name coronary (冠狀) artery.

‘It also looks a bit like a deer’s antlers at first glance….’

Imagine the blood vessels branching out in several directions, surrounding the heart.

This vessel, largely divided into the left and right coronary arteries, plays an important role in supplying oxygen and nutrients to the heart muscle.

But what if this coronary artery becomes narrowed and hardened?

It causes a big problem.

If the blood flow to the heart decreases, it feels like a constricting pain, which is called angina.

What if this condition worsens and a part of the heart muscle is damaged and dies?

A disease that can lead to death if prompt action is not taken: myocardial infarction [heart attack].

As heart disease is the second leading cause of death in South Korea, angina is a very important disease.

“Can you see the risk factors that led the patient to come to the emergency room in this condition?”

I carefully examined the chart on the monitor and answered.

“The patient’s father died of a heart attack, so there’s a family history, and also…”

Long-term smoking.

30 pack-years means 30 years based on one pack a day.

That’s 219,000 cigarettes.

In other words, he’s been chain-smoking almost his entire life.

“He’s been smoking a lot for a long time.”

“That’s right. And from what I heard earlier, the person who brought him to the hospital was a debt collector.”

“Excuse me?”

What is this about?

Ma Dongseop scratched his chin and continued.

“In short, the person who came to collect the debt brought the patient to the hospital. It seems the patient is suffering from debt.”

Smoking.
Heredity.
Stress.

Factors that can cause arteriosclerosis [hardening and narrowing of the arteries].

Unfortunately, this patient has all three.

Moreover, the patient had diabetes, making his blood vessels even more vulnerable.

“Now for a question.”

Ma Dongseop suddenly crossed his thick arms and posed a quiz.

“Why didn’t this person get a stent procedure and instead decided to have surgery right away?”

Not everyone with narrowed coronary arteries undergoes surgery.

Many patients are resolved through a simpler PCI procedure [percutaneous coronary intervention, a non-surgical procedure to open blocked coronary arteries] than surgery.

But this patient….

“Is it because the left main (LM, left main coronary artery) is narrowed and all three vessels are affected? Here, here, and here seem to be narrowed.”

I pointed out the areas that appeared narrowed in the coronary angiography images one by one.

Twitch, Ma Dongseop’s mouth contorted.

…Was I wrong?

But that mouth shape soon turned into a smile.

His face is so rugged that it’s hard to tell the difference between a smile and a frown.

“Oh~ You immediately guessed the CABG (coronary artery bypass graft) indication, and you can read the CAG to some extent, very good! Honestly, I didn’t think you’d be able to answer that.”

“Since it’s the coronary department, I looked it up in advance.”

Ma Dongseop seemed pleased and nudged my arm before saying,

“Anyway, he’s a patient who can get worse at any time, so keep a close eye on him. Put him on NTG (Nitroglycerin, coronary artery vasodilator) and heparin (heparin, anticoagulant)! There are no ICU beds available, so he’s going up to the ward.”

“Yes, then the surgery…?”

“First surgery tomorrow morning. If he gets pain (chest pain) during the night, we may have to do emergency surgery, so keep a close eye on him! If he gets pain, contact the ICU on-call immediately!”

“Yes.”

“You should be able to see patients like this now that you’re a first-year, right?”

I nodded.

Of course, I haven’t even started my first year yet….

Ma Dongseop was already treating me like a resident, and I was acting like one too.

“Keep up the good work! As the chief of thoracic surgery, I’ll give you hard training!”

Hearing that, I felt like a Spartan elite soldier being trained by a trustworthy drill instructor.

* * *

Kim Deoksang was with his elderly mother, who was his guardian.

“What did your mother tell you? To quit smoking a long time ago.”

“I know….”

“When did you ever say you’d give me a good life? You just keep worrying your mother.”

“I’m sorry….”

“It’s a good thing you didn’t cancel your insurance like I told you. Didn’t I tell you that if you listen to your mother, good things will happen? I told you that your life doesn’t end just because your business failed.”

“I get it….”

“Stop looking at your phone for stocks or whatever.”

He was being scolded like a child.

I approached to get the consent form for admission to the intensive care unit after the surgery.

“Hello.”

“Doctor, please scold my child.”

My child.”
The grandmother called Kim Deoksang, who was almost 50, that.

I guess children are always ‘children’ to their parents, no matter how old they get.

“My child’s father also passed away from a heart attack like that….”

The grandmother’s eyes welled up.

I could fully understand her feelings.

I smiled and said to Kim Deoksang.

“The surgery will go well, so don’t worry too much, and please rest.”

“Yes….”

“And quit smoking from now on, as your mother said.”

I received the consent form and left the room.

Why?

I’m particularly concerned about this patient.

Is it because he’s the person whose sternum I’ll be cutting open with my own hands tomorrow….

Or is it some kind of ‘intuition’?

‘……Come to think of it, I haven’t seen the future in a while.’

Since accidents always happened when I saw the future, I thought it was a good thing.

And I hoped that this patient in front of me would be able to leave the hospital without any problems.

As I thought that and returned to the station, a woman with disheveled hair was sprawled out with a hysterical expression.

“Aaaah~ I feel like my mental state is going to collapse!”

Intern colleague, Shin Sangmi.

Since she was the same fixed intern as me, she had been in the operating room several times.

And each time, she would return to the ward with a look of having her soul sucked out.

“What’s wrong?”

“Wow, thoracic surgery isn’t for just anyone.”

I found out a few days ago that Shin Sangmi was the same age as me.

And she was quite straightforward.

At first, it was a bit difficult to adjust, but surprisingly, she wasn’t a bad person to talk to.

While I was quiet, Shin Sangmi was the type to chatter endlessly.

“Didn’t you think about it enough before applying for thoracic surgery?”

“I’ve rotated through surgery a few times, so I thought it would be easy. But…”

Shin Sangmi’s voice suddenly became hysterical again.

“The thoracic surgery operating room is different in many ways! If I had known it would be this hellish, I wouldn’t have come! Don’t you think?”

I chuckled.

I could relate to some extent.

Compared to other surgery departments, the cardiac part of thoracic surgery involves seeing a lot of blood, and the surgery times are also longer on average.

“I went into a valve surgery yesterday. But suddenly, blood spurted out of the aorta, like a fountain to the sky! Have you ever seen the surgical lights covered in blood?”

I haven’t seen it.

But I can imagine it well enough.

The blood in our body is moving faster than you think.

If you were to unfold all the blood vessels in the human body, it would be 96,000 km long, more than two laps around the Earth.

It only takes 1 minute for blood to circulate through those blood vessels.

Calculating the amount of heart exercise in a day, it takes as much force as lifting 30 tons to the top of Mount Everest.

So, if blood spurts from the aorta, where blood pressure is highest in our body, during surgery….

…It’s possible that blood could splatter all the way to the ceiling.

Shin Sangmi said that she shuddered even thinking about that scene again.

“Can I endure 4 years here and get my specialist degree? I might run from thoracic surgery as soon as next month if things go wrong. Isn’t it better to run away quickly if it doesn’t suit you?”

Run, huh….

In short, it means quitting.

Is it possible to run away even though you’ve already been accepted into a department?

Of course, it’s possible. It actually happens sometimes.

There was even a colleague who quit in the middle to reset his intern score after receiving a C on his intern evaluation.

“What are you going to do for a year if you quit now?”

“I don’t know, maybe travel abroad as much as I want~”

She laughs heartily as she says that.

As expected of Shin Sangmi.

She had a personality befitting her nickname of a free spirit.

Shin Sangmi didn’t seem to have any anxiety about her future and career.

“Do whatever you want. It suits me well.”

“Even if blood splatters to the ceiling and it’s a 12-hour surgery?”

“That’s what makes it more fun.”

“Waaa… you’re really as rumored… I was going to try to seduce you just by looking at your face, but you’re scary.”

I chuckled at Shin Sangmi’s words.

She was the type to say things without putting much weight on them, and I ignored her joke.

I glanced at my watch and got up from my chair.

“Where are you going?”

“Operating room.”

“At this hour?”

“I’m going to practice a sternotomy for surgery tomorrow morning. I was wondering if I could ask to touch the sternum saw separately.”

“Wow, what passion? You really seem to like surgery.”

Of course.

I left the ward with a light step.

Unlike Shin Sangmi, everything in the cardiac part of thoracic surgery was new and enjoyable to me.

‘How can you not like this job?’

Rather, I couldn’t understand Shin Sangmi.

And the next morning.

I moved to the operating room for an unforgettable experience of participating in heart surgery for the first time.