Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 158

#158 Happy Birthday (17)

Dr. Song Yu-ju announces the start of the surgery.

The first step is VA-ECMO [Veno-Arterial Extracorporeal Membrane Oxygenation] insertion.

This involves drawing blood from the patient’s vein (V) and returning it to the artery (A) using ECMO [Extracorporeal Membrane Oxygenation, a life support machine that oxygenates blood outside the body].

I held my breath and watched Dr. Song Yu-ju’s hands.

‘The femoral vein is used for this VA ECMO insertion.’

Swoosh—

The ultrasound probe in her hand glides over the patient’s thigh.

Immediately, a cross-section of the arteries and veins passing through the thigh appears on the monitor in front.

These blood vessels are where the ECMO catheter will be inserted.

“Hey, can you tell the difference?”

Suddenly, breaking the silence of the operating room, Dr. Song Yu-ju asks me.

Of course, I know.

I’ve read a lot about ECMO.

I answered quietly.

“Yes. I know that the vein collapses when pressed with the probe, and the artery maintains its round shape.”

Song Yu-ju doesn’t say anything to my answer.

It must mean I’m right.

Soon, her syringe pierces the patient’s skin without hesitation.

Stab—

Bright red arterial blood fills the syringe.

The needle is precisely in the center of the blood vessel, as seen through the ultrasound.

Song Yu-ju’s flawless technique is always impressive.

“Watch the Seldinger technique carefully.”

“Yes.”

.

I was experiencing that firsthand.

It’s different from my bewildered self during my first rotation in March.

Now, half a year later, I was absorbing everything I saw like a sponge.

‘Seldinger technique.’

A technique first devised in 1953 by a Swedish doctor named Seldinger.

First. Puncture the blood vessel with a syringe.

Second. Place a guidewire in the blood vessel.

Third. Remove the syringe and insert a large, thick catheter along the guidewire.

This method allows the catheter to be inserted into the blood vessel without incising the skin.

It is an essential technique in modern medicine, widely used for various procedures involving access to blood vessels, not just ECMO.

‘Seeing it up close makes it clear.’

Even masters have slightly different styles.

Dr. Jangpung was like an unstoppable wave, while Dr. Song Yu-ju is like a cold-blooded machine.

She used her thumb and forefinger to precisely push the guidewire through the syringe hole.

The wire, which had been coiled like a snake, straightened out and entered along the artery.

‘Vitals……’

I glanced at the monitor.

So far, No-eul’s vitals are stable.

‘Right, even in the dream I saw, everything was fine up to this point… Now it’s an unfolding I haven’t seen!’

Dr. Song Yu-ju then widened the path of the femoral artery and said,

“Heparin, please.”

“Yes. Heparin is going in.”

Heparin, a blood thinner.

A drug that must be used to prevent blood clots from sticking to the ECMO and to ensure its normal operation.

“15Fr. A catheter, please.”

“Here it is.”

The operating room nurse hands over the ECMO A catheter with a thickness of 15Fr. (approximately 0.5cm).

Swoosh—

Dr. Song Yu-ju smoothly inserts the A catheter along the guidewire.

Then, she glances at the professor.

“Hmm.”

Thoracic surgeon Professor Heo Jun-im nods.

I thought he was a very talkative person, but he seems to be a man of few words in the operating room.

“You watched carefully, right?”

“Ah, yes.”

I quickly replied to Song Yu-ju’s words.

It was instantaneous.

Everything progressed so smoothly that I don’t know if I can say I ‘watched carefully’.

But Dr. Song Yu-ju’s precise movements and the ECMO catheter entering the artery were a new world I had never experienced before.

I will never forget it for a while.

It was a completely different experience from seeing ECMO insertion during a CPR [Cardiopulmonary Resuscitation] situation back in March when I didn’t know anything.

‘I must have grown through the internship… I think I have a sense of what I need to learn from now on.’

As I was thinking that, the next step immediately followed.

“Can you do the opposite vein, Ahn Gyeong?”

“Yes, Doctor!”

Dr. Ahn Gyeong-sik replied in a lively voice.

Since Dr. Song Yu-ju has taken care of the A catheter on the left, now it’s time to insert the V catheter into the opposite vein.

“Have the intern hold the end of the catheter.”

Is she trying to give me as much experience as possible?

Dr. Song Yu-ju looks at me and nods to the other side.

I moved to the other side and helped Dr. Ahn Gyeong-sik.

The V catheter is longer, so someone had to hold the back of the catheter.

“It’s not a CPR situation, so don’t be nervous.”

“Yes, I understand.”

Ahn Gyeong-sik answers diligently.

Of course, as Song Yu-ju said, ECMO insertion during chest compressions in a CPR situation would be much more difficult.

The current situation is easier than that.

However, for some reason, Dr. Ahn Gyeong-sik seems clumsy from the start.

“Um, Doctor. Was this supposed to go in first?”

After inserting the guidewire into the blood vessel, Dr. Ahn Gyeong-sik asks Song Yu-ju.

Song Yu-ju nods silently.

He looks as anxious as a child left near the water.

‘There shouldn’t be any problems……’

I anxiously watched his fingertips.

Soon, Dr. Ahn Gyeong-sik inserts the V catheter along the guidewire.

Swoosh— Swoosh—

However, it is very different from the procedure Dr. Song Yu-ju did earlier.

‘……Something’s wrong?’

I have a bad feeling.

Is it simply the difference between a master and a novice?

Even to me, who was holding the catheter, something felt off.

Dr. Ahn Gyeong-sik also keeps tilting his head.

“Why is it like this…….”

He leans his body slightly towards the patient and puts more force into his hand.

As he tries to force the catheter in, it begins to bend into an S shape.

I flinched.

‘No, this doesn’t feel like it’s going in smoothly!’

Even a little bit of clumsiness cannot be tolerated in this surgery.

I, who was holding the catheter next to him, grabbed Dr. Ahn Gyeong-sik’s arm without realizing it.

“Ahn Gyeong, hold on.”

At that moment, Dr. Song Yu-ju, noticing something strange, immediately came over to the other side.

“Step aside.”

Soon, Dr. Song Yu-ju, who switched hands, began to push the V catheter in place of Ahn Gyeong-sik.

“This person’s vein is too tough… Is it because they have Eisenmenger’s syndrome [a condition causing abnormal blood circulation in the heart and lungs]?”

Song Yu-ju mutters to herself.

After a little time, Dr. Song Yu-ju smoothly completes the insertion of the V catheter.

“I’m sorry, Doctor…….”

“It’s not your fault, Ahn Gyeong. The patient’s blood vessels are a bit different from normal patients.”

Song Yu-ju then connected the ECMO to the catheters connected to both of the patient’s thighs.

“Professor, I will turn on the ECMO.”

“Okay.”

“ECMO ON!”

With Song Yu-ju’s words, the ECMO starts operating.

Whirr—

Soon, the patient’s blood begins to circulate.

The dark red blood coming out through the V catheter receives oxygen from the ECMO machine and turns into bright red blood, which enters the patient through the A catheter.

The oxygen levels observed on the monitor also naturally rise.

The patient now has a machine outside their body that replaces their heart and lungs.

In other words, there is no need to worry about the patient’s heart stopping during surgery.

‘Did we get past the first crisis……?’

I breathed a sigh of relief.

At that time, Dr. Ahn Gyeong-sik, who was sweating profusely, whispered to me.

“Intern, thank you… I almost made a mistake if you hadn’t stopped me in the middle.”

I nodded lightly and thought.

If we had tried to insert the ECMO in an emergency situation, a mistake might have occurred during this process.

For example, the blood vessel could have been torn due to hasty insertion.

It would have been a big problem if that had happened during the surgery.

In many ways, I thought it was better to insert the ECMO in advance.

“The flow is fine, and the ECMO seems to be working well. Let’s start induction.”

Professor Heo Jun-im said.

Now the thoracic surgery team’s time is over, and it’s the anesthesiology team’s time again.

“I will intubate.”

General anesthesia begins.

The e-tube [endotracheal tube] enters the patient’s trachea, and a ventilator is about to be connected.

“…….”

It’s a tense moment.

In the future I saw in my dream, a big problem called occurred at this point.

What will happen?

I carefully watched the anesthesiology process.

After a few minutes.

“Induction went well, and the obstetrics and gynecology surgery can proceed.”

The anesthesiology professor said.

Is it thanks to the ECMO?

Fortunately, even after the ventilator was connected, the vital signs were stable.

The professors nodded and talked to each other.

“Certainly, the PAP [Pulmonary Artery Pressure] increases after connecting the ventilator. The right ventricle also seems to be struggling.”

“It’s a relief we started with the ECMO, this could have really led to an arrest, don’t you think?”

“Well, we can’t know for sure, but so far, it seems like we did well to proceed with the ECMO.”

“I agree.”

Everyone is in that atmosphere.

I felt relieved.

The words the professors exchanged were proving that my judgment was correct.

‘Good. We safely passed the second crisis…….’

At that moment, Dr. Song Yu-ju glanced at me with a strange look in her eyes from across the room.

She seems to be asking that.

Well, it’s understandable.

Even professors with a lot of experience don’t know many things until they actually enter the operating room.

It’s mysterious that I, an intern, suggested an opinion as if I knew this situation in advance.

‘I was lucky.’

I responded with that look.

Since Song Yu-ju has a good intuition, she might grill me later.

But it doesn’t matter.

Even so, it would be difficult for her to suspect that I saw the future.

‘Let’s focus on the surgery for now!’

The main players standing next to the operating table have now changed to the obstetrics and gynecology team.

From the thoracic surgery team of .

To the obstetrics and gynecology team of .

“Incision begins.”

The obstetrics and gynecology team’s turn.

With Professor Jo Jae-yong’s cry, the full-scale C-section [Cesarean section] surgery began.

I assisted in the surgery as the second assistant, holding the Army [Army-Navy Retractor, a surgical instrument] as usual.

Swoosh—

The professor’s scalpel cuts through the mother’s abdomen and approaches the uterus, and red blood begins to flow around.

“…….”

I’m seeing it for the first time.

The sight of a knife going into someone I know.

But my concentration is no different from usual.

Of course, I was worried before the surgery…….

This is the field now.

From the moment the drape is spread, personal emotions sink to the bottom.

I am only dedicated to assisting in the surgery as a doctor.

“Suction.”

“Yes.”

The professor’s hands move busily.

As the patient’s condition is not good, a tense feeling is felt in the professor’s touch.

He cuts through the abdominal muscles and tries to enter the uterus.

It’s a cesarean section I’ve always seen.

However, it was something different from the surgeries I had seen before.

“Hmm……!”

However, it was something different from the surgeries I had seen before.