A Surgeon Who Uses Martial Arts [EN]: Chapter 80

The Martial Surgeon – Episode 80

Chapter 13: Future (5)

Despite sufficient time having passed for decompression, the patient’s compartment pressure remained unchanged.

Even though the surgery had concluded successfully, the patient’s compartment pressure remained unchanged.

This implied that something was wrong with the patient.

The warm atmosphere of the operating room instantly cooled down.

“No matter how much I think about it, I don’t see any mistakes. Why is this happening?”

Myung-ho frowned, looking down at the shin, the surgical site.

If he or the assistant had made a mistake, he wouldn’t feel so frustrated.

Because he could just blame the error.

But why wasn’t the compartment pressure dropping below 35mmHg even though the surgery was successful?

He felt like questioning the heavens.

“Let’s wait a little longer, Chief.”

“We can’t just keep waiting.”

“Still, we have some leeway, right? This patient might be a special case.”

Tae-woong suggested allowing more time for decompression.

It wasn’t entirely wrong.

Recovery speed is inherently individual.

“But even if it’s a special case, the compartment pressure should have dropped by now.”

“Then wouldn’t it be a special case among special cases?”

“Tae-woong, aren’t you being too complacent because you think the decompression went well?”

Myung-ho chuckled and continued.

“You just don’t want to admit there’s a problem, do you?”

“How can I admit it? The surgery went well.”

Tae-woong replied with a frustrated voice, then tapped the compartment pressure monitor again.

The compartment pressure reading remained unchanged.

Sometimes hitting a broken TV can fix the screen, but…

That doesn’t apply to medical equipment.

“What should we do now?”

“Let’s re-examine the surgical site first. The answer must be there.”

“How about contacting the professor?”

Tae-woong made a new suggestion.

He was suggesting sending an SOS to the professor who was on his way to the hospital.

Although it was the best way to solve the problem, Myung-ho shook his head.

Only one step remained to complete the surgery.

He didn’t want to rely on the professor for that one step.

-To succeed in a fasciotomy [surgical procedure to relieve pressure] alone without supervision, Myung-ho, your skills have improved a lot.

Myung-ho wanted to be praised by the professor.

Therefore, notifying the professor was a last resort.

The urgent moment had already passed.

Taking about 30 minutes to find the cause didn’t seem like a big problem.

Meanwhile, while Myung-ho and Tae-woong were bickering,

Jun-hoo quietly placed his hand on the surgical site.

-Why doesn’t the compartment pressure drop below 35mmHg even though the surgery was successful?

He had a hunch about this question. So he set out to confirm it.

Whoosh.

The internal energy drawn from his dantian [energy center in the body, according to traditional Chinese medicine] spread to the surgical site through his palm.

Jun-hoo was performing an internal energy angiography [using internal energy to visualize blood vessels].

Femoral vein, saphenous vein, perforating vein, reticular vein.

Femoral artery, popliteal artery, tibial artery.

Based on the anatomy knowledge he learned in medical school, Jun-hoo injected internal energy into various parts of the patient’s lower leg blood vessels.

As he worked, beads of sweat formed on Jun-hoo’s forehead.

Sending internal energy to major blood vessels and even capillaries.

It was definitely not easy.

If he failed to control his strength, the blood vessels could burst from the internal energy.

If his concentration wavered, an unfortunate event could occur where he couldn’t send internal energy only to the problematic blood vessels.

Internal energy was definitely a cheat-like power, but the difficulty of control.

And the side effects of using it incorrectly were also significant.

But I have to do it.

I promised the patient, didn’t I?

That I would complete the surgery safely.

If sequelae [after-effects of a disease or injury] remain on his leg in his early 20s, how miserable will the rest of his life be?

Amidst the surrounding commotion, Jun-hoo poured all his energy into internal energy angiography.

With the single-minded desire to wish for the patient’s recovery.

That’s how 3 minutes, which felt like 30 minutes, passed.

Jun-hoo quietly removed his hand from the surgical site.

A smile bloomed on his lips.

He had found the reason why the patient’s compartment pressure had not decreased.

The capillaries extending from the patient’s tibial artery were bleeding.

There were a total of 4 locations in the affected area.

Perhaps because time had passed, the bleeding had solidified into thrombi (blood clots).

The pressure from these thrombi was still affecting the surgical site.

To summarize the situation easily:

1) Because the surgery started around the golden time, the capillaries had already started bleeding.

2) The surgery prevented necrosis [tissue death] of major arteries and nerves, but the previously occurred bleeding is maintaining a certain compartment pressure as it coagulates.

I’m getting help from internal energy again this time.

That’s why I can’t ignore the experience in the Murim [martial arts world].

Perhaps it’s thanks to experiencing so many diverse, urgent, and life-threatening events in the Murim.

Unlike Myung-ho or Tae-woong, Jun-hoo did not lose his composure.

His panic was only temporary.

Having quickly regained his composure, Jun-hoo suspected the blood vessels because there was nothing else to suspect.

The fasciotomy was perfect.

So, as a result of performing internal energy angiography for confirmation.

He was able to discover the thrombi located in the tibial artery capillaries.

The problem is what comes next…

How should I persuade the Chief?

“Chief, how about doing an ultrasound?”

Jun-hoo tentatively suggested the examination.

“Ultrasound? Out of the blue?”

“What’s going to come out of an ultrasound? In the first place, acute compartment syndrome is difficult to diagnose even with CT or MRI.”

As expected, Myung-ho and Tae-woong’s reactions were lukewarm.

Because there are hardly any cases of performing ultrasound examinations for acute compartment syndrome.

It was only natural.

Also, the two did not know of the existence of thrombi.

They didn’t even know that the significance of the ultrasound examination was to discover the size and location of the thrombi, not acute compartment syndrome.

But Jun-hoo knew the inside story of the current situation.

So he couldn’t back down.

“Wouldn’t it be necessary to examine the structure of the compartment with ultrasound?”

“……”

“If we check the tibia and fibula [lower leg bones], fascia [connective tissue] and blood vessels, we might discover something we’ve been missing.”

“There’s no structural problem. I know that best, since I performed the surgery.”

“If there’s no problem, shouldn’t the compartment pressure have dropped more? There must be something we’ve missed somewhere.”

“……”

“The ultrasound examination will fill that gap.”

Jun-hoo passionately argued.

Even though the patient’s condition had improved, they couldn’t afford to waste any more time.

Suddenly, when he stared at the compartment pressure monitor, the compartment pressure showed a slightly increased reading of 37mmHg.

“Hey, Seo Jun-hoo, you’re coming on strong today?”

Tae-woong clicked his tongue and continued.

“I know you’re good at your job, but aren’t you being too forward?”

“I’m just saying that I hope we can do everything we can.”

“Still, ultrasound is way too much. Chief, what are you going to do?”

Tae-woong looked at Myung-ho, asking for his opinion.

Jun-hoo’s gaze also rested on Myung-ho.

The final decision-maker was, without a doubt, the surgeon, Myung-ho.

* * *

“Chief, aren’t you being too lenient with Jun-hoo?”

Tae-woong said with a frown.

In the end, Jun-hoo’s suggestion to do an ultrasound examination was accepted.

As Jun-hoo went to get the ultrasound machine, Tae-woong and Myung-ho were left in the operating room.

“It seems like the intern is already climbing too high.”

“Why do you talk like that?”

“It’s the truth. What does an intern know to give advice? Advice. When we were interns, we couldn’t even breathe in the operating room.”

“Then you should have come up with a progressive suggestion. You were just going to wait and see.”

Myung-ho scolded Tae-woong.

To be honest, Myung-ho was also unhappy with the ultrasound examination.

At least according to Myung-ho’s experience.

Performing ultrasound examinations during surgery for acute compartment syndrome was rare.

But there was no other way.

They couldn’t just sit back and wait.

The surgical site he had examined again had no flaws.

Maybe that’s why.

Isn’t it better to do something?

That one word from Jun-hoo moved Myung-ho’s heart.

It was definitely a situation where they had to do something now.

“If there’s nothing wrong on the ultrasound, can I scold Jun-hoo a little?”

“If there’s nothing wrong, there’s nothing wrong. Why would you scold him with that?”

“It’s because he seems to be acting out of line.”

“Keep it moderate. Don’t get influenced by Dong-seok.”

While they were chatting.

Jun-hoo returned to the operating room with the ultrasound machine.

“Then shall we check it out?”

Myung-ho held the ultrasound stick in his hand.

Myung-ho started the examination, looking back and forth between the surgical site and the monitor.

Of course, Myung-ho didn’t have high expectations for the ultrasound examination results.

You shouldn’t expect too much from a desperate measure.

If there were no abnormalities in the ultrasound examination, he was planning to contact the professor immediately.

“Uh…”

Suddenly, a sigh escaped from Myung-ho’s mouth.

White shadows were found near the calf artery.

“Chief, there was a shadow just now, right? I didn’t see it wrong, did I?”

“You saw it right. I saw it too.”

Myung-ho hurriedly fixed the ultrasound stick on the blood vessel that had just passed by.

Then the appearance of the shadows became clearer.

White shadows the size of fingernails.

Considering the location and size, it was clear that they were thrombi [blood clots].

“So the thrombi were blocking the compartment, so the compartment pressure didn’t drop.”

“That’s right. Jun-hoo’s judgment was right.”

Myung-ho’s gaze turned to Jun-hoo.

He couldn’t see his expression because he was wearing a mask, but Jun-hoo’s eyes were calm.

As if he had expected this result.

He’s definitely not an ordinary intern.

“Hey, Seo Jun-hoo, you’ve done something big? Actually, I was thinking that an ultrasound might be necessary.”

Myung-ho suddenly changed his attitude.

“That’s ridiculous. You were just cursing Jun-hoo until just now.”

“When did I? I never did that?”

Tae-woong denied Myung-ho’s accusation.

Anyway, the reason why the compartment pressure had not dropped was revealed with this.

Since they knew the reason, treatment was also possible.

They could make an incision in the area with the thrombi and remove the thrombi.

Myung-ho finally let out a sigh of relief.

“#10 blade.”

With the scalpel he received from the scrub nurse, Myung-ho made a 4-centimeter-long incision near the calf artery.

He inserted his finger into the incision.

Carefully groping, avoiding nerves and arteries.

After a while, a soft-textured thrombus touched the tip of his finger.

When Myung-ho pulled his finger out of the incision, a thrombus the size of a pinky fingernail appeared.

This guy was the culprit that prevented the compartment pressure from decreasing.

Thud!

Myung-ho dropped the thrombus onto the kidney basin as if throwing it.

He neatly removed the thrombi from the nearby area confirmed by ultrasound.

“I’ll measure the compartment pressure again.”

Jun-hoo, who had been watching the treatment, re-inserted the needle of the measuring device into the surgical site.

The staff’s gazes were all focused on the measuring device’s scale.

The patient’s existing compartment pressure was 35mmHg.

The current compartment pressure dropped to 15mmHg at once.

When the cause was removed, the numbers decreased dramatically.

After re-measuring after about 5 minutes, the patient’s compartment pressure dropped to 7mmHg.

It was within the normal range.

The surgery that was incomplete had been reborn as complete.

While the staff were happily rejoicing with excited expressions.

Jun-hoo silently looked down at the patient.

In fact, Jun-hoo was happier that the patient’s leg was safe because the surgery was successful than the fact that the surgery was successful itself.

To Jun-hoo, surgery was not a stage to show off his talents.

It was about embracing the pain of others.

In the Murim, Jun-hoo was helpless in front of his injured and dying comrades, and he was miserable because he was so helpless.

But modern Jun-hoo was no longer helpless.

With martial arts and internal energy.

Because he was firmly armed with modern medicine.

I kept my promise.

Now it’s your turn to keep your promise. Live happily with healthy legs from now on.

A smile belatedly spread across Jun-hoo’s lips.