Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 205

#205 Hawk Eyes, Woman’s Hands, Lion’s Heart (8)

‘I thought Professor Baek-ui-sin would be here, too…….’

I probably wasn’t the only one who felt puzzled.

Because other people, including Song Yu-ju, seemed to be subtly looking around.

Regardless of that atmosphere, the professors naturally proceeded with the meeting.

“……Therefore, it was deemed inevitable to move up the surgery schedule. The patient is currently hospitalized in the Department of Thoracic Surgery’s intensive care unit.”

Pediatric fellow Dr. Jeong Man-seop briefly presented the echo (echocardiogram) findings and symptoms.

After the briefing, Pediatric Professor Lee Yun-jung opened his mouth.

“LVOTO [Left Ventricular Outflow Tract Obstruction, essentially pulmonary stenosis (PS)] is quite significant, so it won’t be easy. What do you think, thoracic surgeons? Should we move up the surgery a bit?”

Then, Thoracic Surgery Professor Ahn Young-wook nodded.

“Yes, the patient seems to be struggling a lot, and the cyanosis [bluish discoloration of the skin due to lack of oxygen] also looks severe. What is the current weight?”

“5.8kg.”

“Almost 4 months old and 5.8kg……. It seems right to operate within this week.”

Everyone agreed on the timing of the surgery.

The problem was what came next.

“Then, what surgical method are you considering?”

As the discussion of surgical methods began, tension increased in the conference room.

A challenge of modern medicine.

But it wasn’t as if there were no solutions.

Throughout the long history of medicine, doctors have somehow found various answers.

“The first method we can consider is…….”

Everyone focused on the words of the hospital director and professor of pediatrics, Professor Lee Yun-jung.

“……Isn’t Rastelli the first option after all?”

Everyone nodded.

Surgery method number 1.

Rastelli procedure.

A method of creating a connection inside the heart through a hole in the ventricular septum, and then creating a path through an extracardiac conduit [a tube outside the heart facilitating blood flow].

First performed in 1969 and currently the most commonly used surgical method.

However, there is a clear disadvantage.

The extracardiac conduit used to create the path is not a living tissue in our body.

It is bound to break down over time.

Therefore, reoperation to recreate the pulmonary artery path as the child grows is unavoidable.

It inevitably involves the risk of undergoing heart surgery again.

“Rastelli also has the problem of reoperation, and the recently published long-term survival rates are not good either. There is even a report that reported a 20-year survival rate of 52%…….”

Everyone’s brows furrowed at Professor Ahn Young-wook’s words.

‘Is the possibility that a child, who has barely been born for more than 3 months, will die before becoming a 20-year-old young adult more than 50%?’

Indeed, a difficult disease even in modern medicine.

That means that even the surgery method closest to the standard is that dangerous.

I also maintained my concentration and followed the progress of the meeting.

“Then, do you have any other methods in mind, from the Department of Thoracic Surgery?”

Then, this time, Professor Heo Jun-im scratched his head and opened his mouth.

“Oh, I was just about to tell you. There are a few ways to avoid repeated reoperations as much as possible.”

Everyone focused on Professor Heo Jun-im’s mouth.

“First of all, there is also the REV surgery, which is a normal anatomical correction method. Although the patient group is a bit different, Europe has reported a 25-year survival rate of up to 85% with this surgical method.”

Surgery method number 2.

REV (Lecompte) procedure.

A method first attempted in 1981 to compensate for the shortcomings of the Rastelli procedure.

It was a surgical method that improved the method of connecting the so that an extracardiac conduit did not have to be used when connecting the .

However, Professor Ahn Young-wook’s expression was not very good.

“REV also often has problems on the pulmonary artery outflow tract side in the end. Looking at recent data, the results on the left ventricular outflow tract side are not satisfactory either.”

It’s not easy after all.

A situation where risk factors lurk no matter which method is chosen.

But this was not the end.

Professor Ahn Young-wook immediately continued, as if he had been waiting.

“I was wondering if the Nikaidoh procedure would be a good idea.”

Then the other professors’ eyes widened.

They seem surprised about something…… Why are they surprised?

“According to recent reports, the Nikaidoh procedure has been showing good results in the long term.”

He continued forcefully.

“In-hospital mortality after surgery is about 5%, and the remaining patients who were discharged normally have been reported to have no mortality for 30 years. Although it is the result of analyzing only 19 patients.”

At that, Professor Heo Jun-im carefully added.

“It’s the best surgical method anatomically…… but in the long term, I’m a bit worried about regurgitation [backflow of blood] on the aortic valve side, Professor. The scope of the surgery is also wide, and the difficulty is also high.”

Surgery method number 3.

Nikaidoh procedure.

A surgical method that moves the aorta from the root (aortic root translocation) to create a and connection.

It was a surgical method proposed in 1984 with the advantage of being the most normal anatomical correction method.

However, since both the aortic inlet and the coronary arteries had to be moved, the surgical difficulty was high and the scope of the surgery was very extensive.

In the long term, there may be aortic valve regurgitation at the connection site, and reoperation may be necessary on the side as well.

“In my opinion, Nikaidoh is the best in this case.”

Professor Ahn Young-wook was strongly and stubbornly advocating for surgery method number 3, the Nikaidoh procedure.

“Hmm…… Well, there are about three options. Since it’s not an emergency situation that requires surgery right now, shall we think about it a bit more and decide at the next meeting?”

“Yes, let’s do that. If we do the Nikaidoh procedure, I will take on the role of the surgeon.”

“…….”

A strange silence flows for a moment.

I don’t know why, but the atmosphere becomes awkward.

With Professor Ahn Young-wook’s comment as the last, the meeting began to deal with the next patient.

“The next patient is…….”

That’s how the meeting ended, and that same evening.

I lingered around Lee Seul-gi’s side whenever I had a chance.

A child who has not long seen the light of the world.

Her body is still small.

But what is happening in this small chest was by no means light.

A serious defect that occurred with a very accidental probability.

The fact that it was threatening a life felt like a terrible irrationality.

‘I want to save this child no matter what.’

Over the past 3 months.

Before going to sleep in the dormitory, I thought every time I spread out various materials and studied.

‘I’m still lacking.’

‘There are so many things I don’t know in the world.’

Anyone can be brave when they are a beginner, but the more you know, the more humble you become.

As a result, there were times when I lost confidence and my heart wavered.

But seeing the patient’s face directly like this, the goal became clear again.

‘In the dream, it was definitely the 5th day after the surgery.’

The predetermined fate of this child is to be exposed to a desperate situation to the point of receiving CPR on the 5th day after surgery.

I must change this situation.

No, I will change it.

By any means necessary.

‘Which of the three methods is the best for this child? Since it’s an in-hospital event after surgery, I think we should think about safely discharging first rather than the long-term survival rate mentioned at the meeting.’

While I was engrossed in my own thoughts, Dr. Song Yu-ju approached.

“What are you doing here?”

“Ah, Professor.”

“Are the heart interns these days free? Why are you always hanging around the pediatric cardiac intensive care unit?”

Her tone is as sharp as ever.

I told her that I was worried about Lee Seul-gi’s surgery.

Then, Dr. Song Yu-ju’s voice softened somewhat.

“What are you going to do by worrying?”

“Professor Ahn Young-wook was talking about the Nikaidoh procedure. I guess that’s the method they’ll use for the surgery, right?”

“Don’t you even listen to me anymore?”

Dr. Song Yu-ju raised her eyebrows and gave me a scolding, but she answered my question.

“I also think that the Nikaidoh procedure is the most appropriate for Lee Seul-gi among the three. But…….”

Dr. Song Yu-ju’s following words were new information that I didn’t know.

Just a few months ago.

There was a patient who had just undergone Nikaidoh surgery by Professor Ahn Young-wook right before.

And the result was not good.

It was the story that after ECMO [Extracorporeal Membrane Oxygenation, a life support machine] insertion due to arrest [cardiac arrest] in the intensive care unit, he eventually expired (died).

“Did that happen?”

“Professor Ahn Young-wook is good at surgery. But all surgeries inevitably have deaths due to complications with a certain probability. Last time, it was just an unlucky case.”

I felt like I finally knew why the other professors’ eyes were shaking at the conference meeting this afternoon.

‘They were worried because of the previous case. In the premonition I saw, there was also an arrest (cardiac arrest)…….’

Anxiety amplifies.

Dr. Song Yu-ju continued to speak.

“There was probably a problem on the coronary artery connection site. It’s not easy to control that area in Nikaidoh surgery.”

A high-difficulty surgery.

It was the story that no matter which surgeon performs the surgery, complications are bound to occur with a certain probability.

“Professor, then maybe…….”

At that time, my vision darkened.

The gravity disappeared, and a shock as if my body and soul were separated for a moment.

I fell into the darkness more strongly than ever before.

* * *

‘Here is…….’

I looked around.

Pitch-black darkness where nothing can be seen.

Even fear was felt in it.

After a little time, my eyes begin to adapt to the darkness.

Soon, several faintly drawn lines began to appear in front of my eyes.

‘I’ve seen these lines before.’

An abstract space that conceptualizes numerous choices.

Numerous lines of possibilities spread out like crossroads in the darkness.

It was as if I had fallen into the middle of a semi-transparent spider web.

‘The scene visible at the end of this line was the future that would unfold.’

It’s the same as last time.

I felt my body slowly moving along one line, drawn by a weak gravity.

But that line only led to a path surrounded by darkness.

‘If time passes like this, the predetermined future will eventually unfold…… There must be another way I can choose!’

I shifted my gaze.

I have to find a path that shines among these.

Then at the end of that, there will surely be a clue to save Seul-gi.

That’s how I found a way last time.

But…….

I felt a chilling feeling as I looked around.

‘There’s no light?’

All I could see was darkness.

This time, I couldn’t see any paths made of bright light that I wanted to see.

The paths were all dark.

As if submerged in the deep sea without a single ray of light.

‘What happened?’

At that moment, I sensed it.

It was as if someone was whispering a cruel truth in my ear.

No matter how much I struggled, there was no way to save Seul-gi from the beginning.