A Surgeon Who Uses Martial Arts [EN]: Chapter 140

The Surgeon Who Uses Martial Arts-140

The Surgeon Who Uses Martial Arts 140

Chapter 25: Eureka (5)

Brain tumor surgery was an art.

15 centimeters in width.

15 centimeters in breadth.

Unfolding within a head that is 20 centimeters in depth.

It was an art of stopping and advancing.

If one stopped, the tumor could not be completely removed, but damage to the patient’s nerves could be avoided.

If one advanced, the tumor could be completely removed, but nerve damage was unavoidable.

Knowing when to advance and when to stop.

This was the virtue that a great brain tumor surgeon should possess.

Also, brain tumor surgery was static. Unlike tumor surgeries of other organs such as the lungs, heart, stomach, liver, and large intestine, where extreme bleeding occurs and splendid anastomosis [surgical connection between two structures] is performed, brain tumor surgery was not like that.

It was simply about neatly resecting [surgically removing] the tumor.

Stay sharp.

The patient’s life is in your hands.

Ho-young spurred himself on.

As the surgery passed the 3-hour mark, his concentration and stamina began to wane.

His wrist throbbed.

The eyes looking through the surgical microscope became dry and stiff.

His back ached from standing for too long.

But Ho-young thought that if he could save a patient with this much effort, it would be an honor.

The surgery was proceeding smoothly… so far.

Ho-young was performing a radical resection, extensively removing the tumor.

There were two reasons for this.

One was because the patient was suffering from glioblastoma, a stage 4 brain tumor [an aggressive type of cancer that can occur in the brain or spinal cord].

And because there were not many critical nerves passing through the area where the tumor was located.

So today, Ho-young’s surgery was an advancing surgery.

‘He’s an amazing guy.’

‘I think this is the first time I’ve seen a first-year resident do this well.’

Taking his eyes off the surgical microscope for a moment, Ho-young glanced at Jun-hoo.

Using navigation.

Appropriate suction when bleeding occurs in small blood vessels.

Or hemostasis [stopping blood flow] using gauze.

Securing the field of vision from time to time.

Spraying saline to prevent the brain from drying out, etc.

Jun-hoo’s assist was covering the roles of both the second and first assistants.

If you don’t do it right, it’s better not to assist at all.

Jun-hoo’s assist was flawless, meticulous, and concise.

‘How can he use both hands so skillfully?’

Looking at Jun-hoo, Ho-young was saddened by the fact that he himself could not use both hands freely.

“Let’s take a break. Everyone, take a breather.”

As soon as Ho-young signaled for a break, Jun-hoo spoke up.

“Dr. Kwon, can you wipe the sweat off the professor’s forehead?”

“Oh my, you’re right. When did you sweat so much? Professor, just a moment.”

The scrub nurse wiped Ho-young’s forehead with a sterile gauze.

The spot where the gauze passed was cool.

He must have forgotten that he was drenched in sweat because he was so focused.

“Jun-hoo, were you watching my face too?” Ho-young asked, impressed.

“When I was an intern, there was a time when sweat was about to get into a professor’s eyes during surgery, which was dangerous. Since then, I’ve been watching the professor’s face as well.”

“That’s amazing. You’d need three eyes to do what you do.”

“You flatter me. And Professor…”

“What is it now?”

“I’ve been monitoring the intracranial pressure [pressure inside the skull] and electroencephalogram [EEG, a test that measures electrical activity in the brain] since earlier…”

Jun-hoo’s cautious notification followed.

The patient’s intracranial pressure had just risen to 20 mmHg [millimeters of mercury, a unit of pressure].

In the case of the electroencephalogram, abnormal and localized slow waves occurred.

The amplitude of the brain waves decreased.

He said that the alpha waves in the left brain had decreased.

Listening to Jun-hoo, Ho-young monitored the patient’s brain condition himself, and it was exactly as he said.

So Jun-hoo was, while assisting with the surgery, watching Ho-young’s face and even grasping the patient’s brain condition.

His multitasking ability was overwhelming.

“It seems like the patient’s brain is starting to swell slightly during the surgery. Administer diuretics [medication to reduce fluid retention] and muscle relaxants intravenously, and raise the patient’s head slightly.”

“Yes, Professor.”

Jun-hoo moved to the medicine cabinet.

Ho-young stared blankly at his back.

“Was Jun-hoo always that good?”

“Yes, he’s so good at his job that other professors like him a lot too. That’s why I entrusted him with the craniotomy [surgical opening of the skull],” Hee-joon answered Ho-young’s question.

“I wouldn’t ask for anything more if he keeps growing like that. Unlike someone else, don’t go astray.”

* * *

The tumor resection was nearing its end.

The tumor was now on the verge of being removed.

The edge of the tumor that was in contact with the brain became loose.

Ho-young was using a Bovie (electrocautery, electric scalpel) with delicate hand movements.

Chiiiiiik!

White smoke rose as if dancing.

The smell of burning flesh spread near the operating table.

Bovies were mainly used when removing tumors because they can prevent bleeding by searing the tissue.

That’s not to say that a regular scalpel is inferior in performance to a Bovie; it’s just that the purpose is different.

A regular scalpel had a cleaner cut surface than a Bovie. Therefore, a regular scalpel was often used when sutures were required after resection.

Watching Ho-young’s resection, Jun-hoo thought about whether it was possible to incorporate the principles of various swordsmanships while using a Bovie.

‘If he were the surgeon, what if he used a regular scalpel instead of a Bovie when removing a brain tumor, etc.?’

It was a story of the distant future, but that day would surely come someday.

The patient’s intracranial pressure and brain waves returned to normal.

And since the surgery was in its final stages, Jun-hoo’s role was not significant.

So Jun-hoo focused on standardizing Ho-young’s resection into techniques.

He didn’t know if it was always like that or just today, but Ho-young’s surgery was aggressive.

He tried to remove all of the tumor.

The demeanor seemed as fierce as the martial arts of the Mount Hua Sect, which belonged to the Nine Great Sects of the Murim [a reference to a world of martial arts clans and sects in Wuxia novels].

Thump!

Soon, a brain tumor the size of half a thumb fell into the kidney basin.

The removal surgery was a great success.

There was only minor bleeding, and there seemed to be no nerve damage, at least at this stage.

“Jun-hoo, send it for a biopsy.”

“Yes, Professor.”

Jun-hoo cut out a portion of the glioblastoma with a scalpel and placed it in a sterile plastic bag.

And he updated the MRI image connected to the navigation.

The difference between the pre-operative and post-operative images was stark.

The white shadow that had been located in the patient’s temporal lobe had completely disappeared in the post-operative MRI image.

“Whew, thankfully, it ended without any problems.”

Only after checking the MRI image did Ho-young let out a sigh of relief.

“Professor, you’ve worked hard.”

“Thank you for your hard work.”

The staff’s greetings poured out.

Ho-young smiled awkwardly, saying everyone had worked hard together.

While everyone was savoring the relief and sense of accomplishment.

There was someone with a serious expression on their face…….

It was Jun-hoo.

Jun-hoo knew.

No, only Jun-hoo knew.

That a minimally differentiated tumor, undetectable even by MRI, remained in the patient’s head.

Jun-hoo’s gaze was fixed on the MRI image.

About 3 centimeters away from the surgical site.

There, a micro-cancer existed.

Through his internal energy, Jun-hoo clearly felt the micro-cancer.

The tumor’s unique destructive suction.

Now, the problem was how Jun-hoo would explain a tumor that even the MRI couldn’t show.

“Professor. I’m sorry, but may I say something?”

Jun-hoo took a deep breath and spoke.

The battle was just beginning for him.

If he failed.

The patient’s one-year survival rate would drop by half.

From 12 months to 6 months.

The patient’s humble wish to see his grandson or granddaughter would be shattered.

“Yes. Go ahead.”

“The surgery went well, but shouldn’t we also examine the area near the hippocampus?”

Ho-young tilted his head at Jun-hoo’s suggestion.

“You’ve been doing well until now, why are you suddenly talking nonsense?”

“…….”

“Look at the MRI again carefully. Do you see any shadows on the patient’s head? Do you see any shadows in the area you just mentioned?”

“I don’t see any.”

“So, you’re telling me to remove a tumor that I can’t see. Do you think that’s possible?”

“Jun-hoo. You’re crossing the line. Enough is enough.”

Hee-joon, who had been silent, even scolded Jun-hoo.

The eyes of the scrub nurse and the anesthesiologist towards Jun-hoo were also unkind.

Jun-hoo instantly became an outcast.

However, Jun-hoo didn’t feel resentful towards the staff.

In the current situation, anyone would think Jun-hoo was strange.

The surgery went perfectly well.

Yet, he was suggesting to examine another area.

But Jun-hoo couldn’t back down.

Behind him was a cliff.

But what if there was no micro-tumor near the hippocampus?

What if he was mistaken?

A sudden wave of fear washed over him.

If Jun-hoo’s internal energy tumor imaging was based on a mistake.

Even if he persuaded the staff well and they examined the area, Jun-hoo would suffer a great blow.

The staff’s trust in Jun-hoo would plummet.

But Jun-hoo decided to trust himself.

To trust his internal energy tumor imaging.

And if he believed, he had to move forward.

Don’t waver.

You’re doing well.

A resident’s words in their first year might not be believable, but the words of the best neurosurgeon in South Korea should be.

Let’s just go for it.

Let’s show them the ultimate move I’ve prepared.

Jun-hoo calmed his mind and parted his dry lips.

“Everyone probably thinks I’m saying something ridiculous, but that’s not necessarily the case.”

“Then?”

Ho-young glared at Jun-hoo with a displeased look.

“There’s a basis. There’s a paper I read before coming into the surgery. It’s a paper on hippocampal proximity metastasis of glioblastoma occurring in the temporal lobe.”

“Hmm…… I’ve never heard of that paper? Who’s the author?”

“Professor Park Jae-hyun from Jewon University.”

* * *

“The paper really exists. It was published last year. Professor Park Jae-hyun treated a total of 30 patients. It says that 5 of the temporal lobe glioblastoma patients had hippocampal proximity metastasis. It was a micro-cancer that wasn’t visible on MRI.”

“Hmm…… Is that about 20 percent?”

Ho-young hummed at Hee-joon’s report.

He had ignored Jun-hoo, thinking he was talking nonsense, but now it seemed that wasn’t the case.

He had a pretty solid basis.

“You even looked at the paper before the surgery?”

Ho-young looked at Jun-hoo and asked.

“Yes. Because I’m the patient’s primary doctor. Because I want the patient to live long enough to see his granddaughters and grandsons.”

“Huh…… You have a knack for surprising people multiple times.”

Ho-young turned his gaze to the MRI image, where not even a trace of shadow could be seen.

If Jun-hoo’s suggestion was based on Park Jae-hyun’s paper, he couldn’t just ignore it.

Park Jae-hyun.

A self-proclaimed and publicly recognized genius neurosurgeon in South Korea.

Brain tumors.

Cerebrovascular.

Spine and cervical spine.

Even stereotactic neurosurgery.

A master who had mastered all fields related to neurosurgery.

Perhaps a maestro.

But Ho-young had one part he couldn’t understand.

How did Park Jae-hyun even think of looking for micro-cancers that weren’t visible on MRI?

Usually, it was difficult to do such reckless actions.

Because the wider the surgical area, the more burden it put on the brain.

“Even if there are research results from Professor Park Jae-hyun, do we necessarily have to follow them?”

Hee-joon continued calmly.

“I think examining the area near the hippocampus has more disadvantages than advantages.”

“I think differently.”

Jun-hoo immediately started to refute.

“20 percent is a figure that can’t be ignored. Furthermore, in the case of glioblastoma, the patient’s survival rate drops sharply upon recurrence, and considering the patient’s age, reoperation is also difficult.”

“…….”

“I think we should check everything when we open the head once.”

“Jun-hoo, don’t you know that too much is as bad as too little? There’s no need to take that much risk to check for a tumor that may or may not be there.”

“If there’s a tumor when we examine the area near the hippocampus, it’s good to remove it. If there isn’t, it’s good to be relieved, isn’t it?”

“Both of you, stop.”

Ho-young stopped the two’s argument in a low voice.

He nodded as if he had made up his mind.

“It would be good to widen the incision and check it first.”

“Professor. That’s too dangerous.”

“I can’t stand leaving any room for doubt. Everyone, I’m sorry, but let’s try a little harder.”

Ho-young encouraged the staff and widened the incision.

He went through the cumbersome process of performing another craniotomy and removing the meninges.

Ho-young was more drawn to Jun-hoo’s words.

20 percent was definitely a figure he couldn’t pretend not to see.

Especially if the author of the paper was Park Jae-hyun.

After widening the surgical area to the vicinity of the hippocampus.

Ho-young brought his eyes close to the micro microscope.

Contrary to his worries, no tumor was visible.

Was Park Jae-hyun wrong.

Was Jun-hoo also wrong?

Still, just in case, he increased the magnification of the microscope to the maximum of 25 times.

If it was a micro-cancer that the MRI couldn’t detect, it was necessary to observe it more carefully.

“…….”

“…….”

Amid the tense silence and tension that gripped the operating room.

Ho-young frowned and thoroughly examined the area near the hippocampus.

“Ah…….”

A sigh that flowed out eventually.

In the end, Park Jae-hyun was right.

Jun-hoo was also right.

In a place 2 centimeters to the left of the hippocampus.

There was something shining like a red dot.