Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 188

Dr. A Fresh Surgeon – #188 Fresh Thoracic Surgeon (5)

The upper surface of the sternum.

A place where unexpected bleeding can occur.

I moved my hand along the manubrium [the broad, upper part of the sternum] towards the patient’s neck.

Zzzzzz—

My Bovie [electrocautery device] cauterized the soft tissue of patient Kim Deok-sang.

Meanwhile, Dr. Ma Dong-seop held an instrument in one hand and lifted the end of the incision.

“Okay, I’ll pull here, so check the jugular notch along the sternum!”

A situation where dissection is needed higher than the incised area.

It was essential for the assistant to brighten the field of vision.

As Dr. Ma Dong-seop’s arm muscles flexed, my view became clearer.

‘Do you need strength to perform surgery well?’

Having only been in the assistant’s position, I had never seen the field from the surgeon’s perspective.

But…….

‘Now that I’m in the surgeon’s seat, I understand how important a good assistant is to the surgery!’

Brightening the field of vision and providing suction where needed.

It seems simple, but it greatly affects the smooth progress of the surgery.

I understood why professors sometimes yell at the assistant in front of them and have so many requirements.

‘Trust Dr. Ma Dong-seop’s assistance and proceed! Surely, according to the future I saw…….’

I would cause bleeding while dissecting this area, and my vision would be stained with blood.

Therefore, my fingertips moved more delicately, and my concentration was heightened.

“What, suddenly cautious? There’s nothing to it, just go along the sternum!” Ma Dong-seop said.

He seemed eager to quickly clear the upper surface of the sternum and start sawing.

But I calmly proceeded with the dissection, regardless of his words.

‘I need to maintain my pace.’

I am confident in my concentration.

Before I knew it, the excited feeling had disappeared.

The melody of Bach flowing in the operating room had changed to Chopin.

‘The selection is good too.’

Let’s proceed calmly.

There is a strong ligament connecting both collarbones on the upper surface of the sternum.

To secure a field of vision for heart surgery, this ligament must be carefully cut.

I carefully cut the ligament and began to calmly clear the surrounding soft tissues.

As I carefully moved my hand, my eyes widened as I discovered something.

“……!”

The upper surface of the sternum.

A long structure running horizontally was visible.

It was still difficult to tell exactly what it was, but there was something with a smooth surface where my headlight was pointing.

‘Found it!’

A blood vessel crossing the upper surface of the sternum.

Its appearance was not completely visible as it was surrounded by fatty tissue and soft tissue, but it was definitely a blood vessel.

‘……So this was the guy that was going to fluster me.’

I gently pushed with the end of the Bovie, gradually exposing the blood vessel, and said.

“Doctor, I think there’s a vessel passing through here?”

Then Ma Dong-seop’s eyes widened.

“Huh? What? Let’s see.”

Ma Dong-seop continued to pull the instrument with his right hand and leaned his head in front of me.

“Oh, really?”

Ma Dong-seop began to touch the area of the blood vessel I had found with forceps.

“Yeah, that’s right, sometimes a thick vein passes through here like this. How did you know?”

“While dissecting, it just didn’t look like soft tissue.”

At my answer, Ma Dong-seop glanced at my face with an interesting look.

“As expected of Shin Seon-han, you don’t disappoint. How did you find even this on your first time?”

Once again, a sense of satisfaction was evident in Ma Dong-seop’s eyes as he looked at me.

“What’s expected is expected.”

It was a short and impactful compliment.

‘Whew…… that’s a relief.’

What if I had proceeded at Dr. Ma Dong-seop’s pace?

Bleeding would have definitely occurred.

Of course, Dr. Ma Dong-seop would be able to handle bleeding from such a small blood vessel.

However, my case is different.

Today is my first sternotomy [surgical procedure involving incision of the sternum].

If unexpected bleeding occurred, I would have had to switch places with Dr. Ma Dong-seop and go back to the assistant’s position.

“We need to clip the blood vessel, do you want to try?”

Before I knew it, the nurse was next to me, preparing a disposable hemo-clip instrument and waiting.

Hemoclip (Vessel hemo-clip) – A surgical tool shaped like tongs, where a clip is attached to the end of the instrument when the handle is pressed like scissors.

“Yes, I will try.”

I received the hemo-clip from the nurse and held it in my hand.

“Wow…… Shin Seon-han, you’re trying everything on your first sternotomy? I wasn’t originally planning to let you do this…….” Ma Dong-seop said that, but he taught me how to use the hemo-clip with a one-point lesson.

A strong trust is felt.

If you gain trust in the operating room, you can get more opportunities.

Click—

The ends of the blood vessel were clipped, and the space between them was cut with scissors.

The neatly cut sides of the blood vessel revealed their appearance cutely.

And thanks to the clip, blood did not flow from the cut surface of the blood vessel.

“Okay, now for the final preparation stage. Find the midline of the sternum!”

Now is the important part.

We each pressed the space between the ribs with forceps to mark the boundary line on the side of the sternum.

Then, we marked the midline by burning the sternum with a Bovie in the center of both sides.

It was to mark the place where the sternotomy saw would pass.

The preparation was complete. It was time to cut the patient’s sternum.

“Here is the sternotomy saw.”

I finally held the saw.

It was heavier than I thought.

As I had learned, I started by checking if this instrument was well-maintained.

Weeeeeeng—

When I pressed the handle button, the saw blade started to move.

After confirming that it was working well, I held the saw and started sawing from the xiphoid process [the cartilaginous section at the lower end of the sternum].

Weeeeeeng-eek-eek—

……At first, it didn’t go well.

The sound was strange too.

The sensation of cutting bone for the first time was unfamiliar.

“It’s okay, it’s okay. It can be like this when you first start sawing. It’s natural, since it’s about cutting through bone.”

Dr. Ma Dongseop reassured me.

I started pushing the saw forward little by little.

The saw, which had been spinning idly a few times, began to move forward gradually, and once it started, it proceeded smoothly.

Weeeeeeng—

Following the midline I had marked in advance, my instrument continued to advance.

If I lost focus even for a moment, it felt like I would deviate from the midline.

So, I had no choice but to concentrate, alternating between looking at my fingertips and the path I had to take.

Jijijik— Thud!

‘Got it!’

Finally, my saw reached the end of the upper surface of the sternum [breastbone], and I completed the sternotomy without any issues.

“Good job! It’s nothing, right? Hehe.”

Just doing the first step of heart surgery was this difficult.

Still, I was glad that I could complete my first task in the operating room without any problems.

Mission complete!

“I’ll take care of the final hemostasis [stopping blood flow], so you can go. You must have a lot of work in the ward, right?”

“Yes, Doctor. Thank you for teaching me so well!”

“Is this really your first time? How are you doing so well?”

The nurse’s compliment was a bonus.

After bowing to the people, I came out of the operating room and thought.

‘A small blood vessel could make me so flustered… I guess it’s important to experience many cases.’

Baek Euishin had said something like that.

Patients’ anatomies are all different.

It was a moment to experience that fact firsthand.

The knowledge I had known in my head until now was finally beginning to stick to my body through the experience in the operating room.

* * *

10 a.m.

Heart surgery does not end in a short time.

Especially in the case of CABG [Coronary Artery Bypass Grafting] surgery, it takes at least 4 hours, no matter how fast it is.

I couldn’t just stand around and watch in the operating room during that time.

Of course, I would like to watch the surgery process until the end, but….

‘Let’s take care of the ward work first!’

The intern’s hands must not stop even for a moment.

I quickly went up to the ward and took care of the pending tasks.

Prescription work and consent forms.

Patient dressing.

Etc.

After finishing the last chest tube removal task, I returned to the station.

Shin Sangmi, who had finished her intern duties like me, approached me excitedly.

“Hey, hey, I heard you’re doing a sternotomy today?”

“Yeah. I already did it.”

“Seriously? They said they would let me do it too, but I’m too scared, so I’m putting it off… How was it?”

Shin Sangmi’s voice, asking that, is quiet as if holding her breath.

“It was fun.”

“Cutting people’s bones?”

“Yeah.”

“How is that fun…? Well, I can tell by your expression.”

“What’s my expression like?”

“It’s the expression you make when you confess to your crush and come home after declaring that you’re dating from today.”

…Is it that much?

Anyone who hears it would think I’m a weird person.

Well, the expression ‘crush’ might not be wrong.

Because I’ve been dreaming of holding a scalpel in that position for over 10 years.

“But why have you been lowering your voice since earlier?”

“Didn’t you know? There was a commotion this morning. The atmosphere is not good right now.”

“Why is the atmosphere like that?”

“It seems like Dr. Ahn Gyeongshik mismanaged a patient. The professor was very angry.”

“Ah….”

Come to think of it, Dr. Ahn Gyeongshik being scolded by the professors was a daily occurrence.

It was the same in the esophagogastric part, and it seems to be the same in the adult heart part.

“Were things flying around?”

“Things?”

“When I first came to the Department of Thoracic Surgery, things were flying around.”

“Wow, seriously. If they throw something at me, I’m quitting the Department of Thoracic Surgery that day.”

Today, Shin Sangmi was once again calculating her escape from the Department of Thoracic Surgery, as if it were a habit.

I chuckled and stood up.

“It’s up to you how you decide, but I hope we can get our specialist degrees together since we’ve already started.”

“What, suddenly a display of camaraderie?”

“Shouldn’t we have a colleague to lean on during the difficult TS [Thoracic Surgery] residency?”

Then, Shin Sangmi looks at me as if surprised.

Are you even capable of saying such things?

That’s the look in her eyes.

“Where are you going?”

“I’m going to the cafe downstairs for a bit.”

“Do you even have time to rest?”

“I’m not resting, I’m going to get some coffee for the people in the operating room.”

Not only the Department of Thoracic Surgery, but every surgical department has its own culture.

You could call it a long-standing custom.

After having an experience worth commemorating, the resident or fellow treats the people who helped me in the operating room.

While I was in the position of the chief surgeon, everyone was nervous and focused on preventing any accidents, so it was enough to treat them.

‘Let’s see, there were 6-7 people in the operating room besides me….’

Four cups in one hand.

I took a total of 8 cups of daily yogurt and coffee from the cafe on the first basement floor in a paper carrier and got on the elevator.

Of course, this coffee will be cold after the surgery is over….

The schedule of the surgical department is not generous enough to enjoy the leisure of freshly brewed warm coffee.

The only option is for people to come out and eat in between breaks.

“Sunhan, hello.”

“Ah, hello.”

“Are you going to the operating room on the 3rd floor? I’ll press the button for you.”

“Thank you.”

I exchanged simple greetings with the nurse I met in the elevator.

As I approached the operating room lounge to bring the coffee.

Ring-ring-ring—

The pager in my pocket rings.

Oh, I have to answer it?

It was a miracle that I didn’t spill the coffee in the midst of all this.

I barely put the coffee down on the chair in the hallway and took out my phone.