Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 145

#145 Happy Birthday (4)

Cesarean section.

It’s a surgery to open the abdomen and deliver the baby.

To be precise, this method of delivering a fetus by incising the abdominal wall and uterine wall is abbreviated as C-section.

There are several theories about the origin of this name.

The most well-known is that the Roman Emperor Caesar was born this way.

Alternatively, there’s a theory that it originated from the Latin word meaning ‘to cut.’

—Previous cesarean section

—When normal delivery is difficult due to dystocia [difficult or obstructed labor]

—When the baby is in breech position, with the buttocks coming out first, not the head

—When the fetus is in poor condition, etc…….

There are various situations in which cesarean sections are performed.

Of course, recently, there are many cases where it is performed at the request of the mother.

More than a quarter of births worldwide are performed by cesarean section, and the proportion continues to increase.

‘Of course, in a situation like this, it’s a must!’

Patient Lee Ye-ji.

Due to preeclampsia [a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the kidneys], her kidney levels deteriorated rapidly, and she underwent an emergency cesarean section.

“Doctor, I’m fine… Can’t you wait a little longer?”

When I entered the high-risk inpatient room, the patient lying down was having that conversation with her attending physician.

The patient is currently 34 weeks pregnant.

If you divide the pregnancy period into trimesters, it is as follows.

—Early stage: First 14 weeks

—Middle stage: 15 weeks to 28 weeks

—Late stage: 29 weeks to delivery

Normal delivery usually occurs at 39-40 weeks, and delivery before 37 weeks is considered premature.

The fetus in the womb is exposed to various risks as an incomplete being if it comes out before completing the gestational weeks.

So, it is understandable that the mother is worried about delivering the baby early.

However, the attending physician, Dr. Yoo Jung-nam, said firmly.

“No. If we delay any longer, your kidneys will be damaged, and you may have to undergo dialysis for the rest of your life. The professor is on their way now, so we need to get you to the operating room quickly.”

Of course, it is best for the baby to stay in the mother’s womb for as long as possible.

However, that was no longer an option.

If left as it is, the mother’s body will be irreparably damaged.

The ultimate goal of obstetrics is to protect both the mother and the baby safely.

“Patient Lee Ye-ji, let’s go to the operating room!”

I hear the nurse’s words.

Soon, transport to the operating room will begin.

At that time, the husband, who had been constantly by the patient’s side, came and said.

“Um, doctors. Can I come into the operating room too…….”

“No, you can’t.”

The nurse firmly refused the husband’s request.

This is an emergency surgery, not a planned C-section.

All factors that could delay the surgery, even a little, are excluded.

In any case, safety and life are the top priorities.

Beep—

I pulled the bed with the patient lying on it and entered the operating room.

The patient, who had been hospitalized for 5 days, was not in good condition.

Her hair is disheveled.

Her lips are pale, and her belly is greatly swollen.

However, the patient seemed to be more worried about the baby who would be born soon than about her own condition.

“…….”

The patient is trembling on the operating bed.

Half because the operating room is cold.

And half because of worrying and scary feelings.

Even though peaceful classical music is playing, her expression does not calm down easily.

“Okay, turn slightly to the side, look at your belly button, and curl up. I’ll be holding you from the side, so don’t worry.”

I helped the anesthesiologist.

Cesarean sections are usually performed with lower body anesthesia [spinal or epidural anesthesia].

At this time, it is also the intern’s role to position the patient and assist with anesthesia.

Soon, the patient who was lying on her side and bent her back was anesthetized, and I took my position for the surgery.

After disinfecting, the professor came in wearing a surgical gown.

“Professor……!”

The patient showed a happy expression when she saw the familiar professor.

She was disoriented among people she didn’t know well, but she seemed relieved to see someone she could rely on.

“Is it okay to take our baby out now? It’s only 34 weeks…….”

She said that and sobbed.

But the professor reassured the patient with a skillful tone.

“34 weeks is fine, it’s not too early. I’ll do my best, so don’t worry.”

The patient’s diagnosis is preeclampsia.

Commonly called ‘pregnancy poisoning’.

It is one of the hypertensive diseases during pregnancy in which high blood pressure and kidney damage occur.

In many cases, the cause is unknown, and if it worsens, it can be accompanied by kidney damage as well as seizures or eclampsia [severe seizures during pregnancy].

Treatment?

It is to deliver the baby!

For the health of the mother, even if she has not reached 40 weeks, she must give birth through surgery.

“Scalpel.”

Soon the surgery began.

Swish—

The professor takes the scalpel and begins the incision at the lower abdomen.

In gynecological surgery, a vertical incision was sometimes used, but this time it is a transverse incision.

When the skin is cut lengthwise, blood flows out.

Of course, all of this process is hidden, so the patient herself cannot see it.

“Bovie (electrocautery) [a device used to stop bleeding by using heat].”

Chiiik—

The professor continues to cut open the abdomen while pressing the bovie button.

The smell of burning fat stings the tip of my nose.

“Hold this, Army!”

“Yes.”

I grabbed the forceps that the professor handed me in one hand, and busily moved while pulling the Army-navy retractor (a surgical instrument for pulling tissue) with the other hand.

Now, this Army instrument was so familiar that it felt like an extension of my hand.

‘Because I was holding this all the time for 2 weeks in the gynecology department!’

In the field of vision I secured, the professor and resident doctor sped up even more.

Soon the abdominal muscle layer was peeled off, and then the peritoneum [the membrane lining the abdominal cavity] was opened.

Then, the mother’s uterus, mixed with pink and purple, appeared.

The professor’s hands were unhurried.

How many seconds had passed since he picked up the knife?

The uterus was already beginning to appear.

The uterus, with its bare face, had a texture that looked harder than I thought.

This time, I held a slightly larger instrument than the Army and brightened the professor’s view.

The field was busy.

The professor had already grabbed the scalpel again and made a thin cut in the uterus.

Then, this time, he handed the scalpel he was holding back to the nurse and shouted.

“Mayo scissor!”

Mayo scissor [a heavy scissor used for cutting dense tissues].

A sharp scissor-shaped surgical instrument.

The professor began to carefully open the uterus.

Unlike the speedy progress so far, the professor’s hands were delicate.

This is probably to avoid leaving scars on the fetus in the uterus.

Right then,

Gurgle!

Amniotic fluid burst out.

Amniotic fluid [the fluid surrounding the fetus in the uterus].

A thick liquid with a yellow and slightly greenish color that was with the fetus in the uterus.

This liquid, which is maintained at a constant temperature, allows the fetus to move smoothly and also protects it from external shocks.

I immediately suctioned the flowing amniotic fluid.

Then, I saw a purple, squiggly umbilical cord in front of me.

The professor placed the umbilical cord in one direction and put his hand into the uterus.

At that time, my eyes widened.

‘Huh? What is that?’

I couldn’t recognize it for a moment.

Between the split patient’s abdomen, something sparse and dark was visible.

Only after a while could I figure out what it was.

‘……It’s a baby’s head!’

I felt like an idiot for a moment.

Isn’t it obvious?

What else would be in that place besides the baby’s head?

But no matter how much I knew it theoretically, seeing it with my own eyes was a completely new experience.

Squeeze—

The professor, who put his hand into the uterus, gently wrapped the baby’s head and began to take it out of the womb.

As instructed, I gently pressed the mother’s belly to help the baby come out.

Not too strong, not too weak.

Soon, the baby began to emerge with the umbilical cord.

The head and torso soaked in amniotic fluid, and the back of the fetus’s head were visible.

As the professor’s hands moved skillfully, the baby’s back began to be seen.

Various substances in the amniotic fluid stuck to it, and the flesh-colored back was stained with purple and white.

Soon, the fetus came completely out of the mother’s uterus, and the professor lifted the baby.

‘……!’

The first cesarean section I had ever participated in, watching the baby come out was truly an amazing moment.

It was 1 hour and 30 minutes after the emergency cesarean section was decided.

“It’s 0:26 AM.”

The nurse announces the time of birth.

……Uwaaah!

As if in response, the baby begins to cry, making its first voice to the world.

34 weeks.

Not big, but admirable.

Tak—

The umbilical cord is cut.

I also check that there are 10 fingers and toes each.

Now that the fetus has been taken out of the uterus, should we suture and finish the surgery?

That’s not it.

The placenta remains in the uterus.

The placenta [an organ that develops in the uterus during pregnancy], which is connected to the umbilical cord, is an organ that connects the fetus and the mother’s uterine wall.

Through the blood delivered through this placenta, the fetus received oxygen and nutrients from the mother.

But now that the umbilical cord has been cut, the fetus must survive by breathing and eating on its own.

Then what about the unnecessary placenta now?

That’s right.

It must be removed.

The professor grabbed the umbilical cord and began to press on the abdomen to remove the placenta.

But this is bigger than I thought.

Gurgle—

Almost an armful of tissue poured out of the mother’s belly all at once.

At the same time, the mother was meeting the fetus beyond the surgical screen.

“Mother, let’s see the baby’s face.”

It was the moment when the baby, who had lived as one in the womb, was now visible in front of her eyes.

After being well wiped by the nurses, the baby with a clean appearance faces the mother’s face.

The mother, still lying with her stomach open, gave her first greeting to the baby with a touching expression.

“Hello, Gituk.”

Of course, the child has no answer.

She is still crying with the most unfair expression in the world.

The mother smiled as if happiness was seeping into her bones, even though she was disoriented.

It was literally overwhelming.

After a short meeting, the baby is soon moved to the newborn room outside the operating room.

“Now that you’ve seen the baby’s face, I’ll put you to sleep for a while.”

The anesthesiology department administered a sedative to the mother, and the cesarean section was entering the final stage.

The professor checked the inside one last time.

This is a process to check whether there is any bleeding in the uterus during childbirth.

“No bleeding…… Okay.”

After confirming that there was no bleeding, the professor began to suture the uterus.

While the resident doctor standing opposite assisted, I suctioned and brightened the field of vision.

‘Amazing.’

I wondered what I had just witnessed.

Isn’t sharing the moment when a life is born like this one of the most sublime experiences a doctor can have?

I felt like I had grown once again with new experiences and awe.

* * *

About 1 hour later.

The surgery is over.

I immediately moved the mother to the recovery room.

The husband, who had been restless outside the operating room, followed her to the recovery room.

Cesarean section is fast and safe, but pain starts after surgery.

Therefore, attention must be paid to pain management, and other postoperative complications must also be taken into account.

The attending physician and nurses will continue to take care of her.

“Hoo.”

I returned to the station.

While doing ordinary intern work, I felt like I had accomplished something only after assisting in the surgery.

‘The lingering feeling still remains.’

At that time, the resident doctor on duty who had entered the surgery with me took off his mask and approached me and said.