Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 191

#191 A Fresh Thoracic Surgeon (8)

‘Get a grip!’

Clap, clap—

I slapped my cheeks.

To think I’d start seeing the future even in my sleep…….

It felt like I’d been hit with a bucket of water out of nowhere.

Thanks to that, I had to do some physical comedy, rolling off the bed for the first time since elementary school.

‘It wasn’t just a nightmare. I definitely saw a scene from the future!’

I jumped up and sat at my desk.

The scenes from the operating room in my dream were starting to fade.

Like a handprint on fogged glass, the memories seemed ready to disappear at any moment.

I grabbed a pen and started taking notes, trying to recall the information before it evaporated.

‘Let’s write it down one by one before I forget.’

—V-fib (Ventricular fibrillation: a life-threatening heart rhythm).

—Tamponade (Cardiac tamponade: compression of the heart caused by fluid accumulation).

—Near arrest (Near cardiac arrest: imminent cessation of heart function).

—Compression (Chest compression: a technique used in CPR).

—Late incision, chest full of hematoma [a collection of blood outside blood vessels], etc…….

‘It’s a complete disaster.’

I roughly ruffled my hair with the end of the pen.

If these events really happen as they did in the dream, can patient Kim Deok-sang survive?

Probably not easily.

As the time with insufficient oxygen supply continues, even if he survives, the aftereffects will be severe.

So, I had to prevent the worst-case scenario I saw in the dream at all costs.

‘The fact that tamponade occurred means there was severe bleeding, and blood filled the area around the heart…….’

Come to think of it, the middle school student who had an accident in Gangnam Station last year was also a tamponade patient.

However, this case is much more complicated.

He’s a patient who underwent CABG (Coronary Artery Bypass Graft: a procedure to improve blood flow to the heart) surgery, and there was even a ventricular fibrillation event.

It’s an excessively difficult mission for me, who is just in my first year of being a TS (Thoracic Surgeon).

‘……Let’s move. There will definitely be a chance for me to change the future.’

Tap—

I quickly grabbed my gown and rushed out of the room.

First, I ran to the lounge and sat in front of the computer to pull up the chart.

This is the fastest way for me to check the patient’s condition right now.

“……”

Click, click—

I scrolled through the chart with the mouse.

First, I need to check the patient’s bleeding.

While quickly scanning the monitor, one important piece of information caught my eye.

#1 CTD drain

220 180 40

#2 CTD drain

190 170 30

The change in drainage volume through the chest tube is being recorded on an hourly basis.

However, the drainage volume has decreased sharply in the last hour.

‘The bleeding is stopping, so isn’t that a good thing?’

Wait, no.

I shook my head.

I can’t just rely on this chart to understand the patient’s condition and feel relieved.

‘If tamponade occurred, it means the area around the heart is full of blood due to bleeding…… but the chart is saying the opposite. That’s strange?’

The suspicion grows more and more.

Suddenly, the words of the White-Clad God come to mind.

You have to see and feel the patient directly.

The moment you try to understand the patient only through the chart, you might miss something really important.

I have repeated those words countless times, so they were deeply engraved in my heart.

‘I have to check this myself!’

Thump!

I burst out of the dorm room.

The way up to the intensive care unit felt longer than usual.

As I arrived at the door, panting, someone called out to me in a surprised voice.

“Seon-han ssaem [Korean honorific for ‘teacher’ or ‘doctor’]? What’s wrong?”

I ran into Nurse Cha Yu-ri, who was on duty.

“Is patient Kim Deok-sang okay?”

“That patient from earlier?”

Nurse Cha Yu-ri answered my question with a puzzled expression.

“Well, there doesn’t seem to be any major problem, but he’s getting a lot of medication. You could say it’s a bit different from the usual course…….”

“Does Doctor Ahn Gyeong-sik know about it?”

“Of course.”

I straightened my disheveled clothes and approached the bed.

Fortunately, the vital signs displayed on the monitor were still within the normal range.

However, even if they are within the normal range, if the dosage of drugs such as cardiotonics being administered to the patient is high, that situation cannot be considered normal.

It’s like thinking that the height measured while wearing shoes with heels is your actual height.

“Dobutamine (cardiotonic) and even epinephrine (cardiotonic)…… Do you usually use this much?”

“Ah, they just asked me to increase the medication and give more volume, so that’s what I’m doing.”

As she said that, Cha Yu-ri added.

“Fortunately, the chest tube drainage seems to be decreasing little by little?”

I narrowed my brows.

As Nurse Cha Yu-ri said.

The fact that the amount of bleeding coming out through the chest tube was decreasing was good news.

But…….

Why do they need more medication and more volume?

I looked at the urine bag I had seen earlier once again.

‘The color is much darker?’

The color of the urine falling into the urine bag was as dark as honey, and the rate at which it was falling was also significantly slower.

A typical sign that the heart’s strength is insufficient.

I recalled what I had studied in the past and examined the patient’s condition more closely.

If I were the intern I was last year, I would have passed it without a second thought.

But it looked different to me now.

‘If you think about Beck’s triad [a set of three medical signs associated with cardiac tamponade], which I also looked at during the Gangnam Station incident…….’

First, hypotension [low blood pressure].

The blood pressure doesn’t seem low, but even if the blood pressure is low, it can appear normal through medication.

Second, jugular vein distension [swelling of the jugular veins in the neck].

Jugular vein distension, which is evidence that the central venous pressure is elevated.

The CVP (central venous pressure) value on the patient’s monitor is fluctuating between 10 and 11.

“Nurse Cha Yu-ri, this patient’s CVP seems a bit high.”

“That’s right, I was just about to…….”

Just as Nurse Cha Yu-ri was about to say something, Doctor Ahn Gyeong-sik appeared.

“Seon-han ssaem? What brings you to the intensive care unit at this hour?”

He had a languid expression.

His hair was sticking up, as if he had just taken a nap during his shift.

“The patient’s drainage suddenly decreased, so I was wondering if the patient’s condition had improved.”

“Keu~ As expected of Seon-han ssaem. You’re paying so much attention because he’s the first patient you did a sternotomy [surgical procedure where the breastbone is cut open] on, good, good.”

The attending physician, Doctor Ahn Gyeong-sik, smiled and praised me.

“I checked 30 minutes ago, and fortunately, the bleeding seems to have stopped. I’m planning to extubate (remove the ventilator) tomorrow morning.”

Doctor Ahn Gyeong-sik’s answer was mixed with a yawn.

He didn’t seem to have any particular doubts about this situation.

I became anxious.

Doctor Ahn Gyeong-sik is the one behind the wheel right now, and I have to turn the steering wheel.

Before the car rolls off the cliff.

“Is there any chance that the patient might develop V-fib or go into arrest due to tamponade?”

“V-fib? Tamponade?”

“Yes. Like there’s hidden bleeding…….”

Perhaps another doctor would have been taken aback or burst into anger.

Because it would seem presumptuous for a subordinate to give advice so boldly.

However, Doctor Ahn Gyeong-sik seriously considered my concerns.

“Since the drainage has decreased, it’s right to assume that the bleeding has stopped, but…….”

“What if there’s another reason?”

“Pardon?”

“If the chest tube is blocked, wouldn’t we not know even if there’s bleeding?”

Doctor Ahn Gyeong-sik’s complexion began to change at my words.

Second year of thoracic surgery.

He is rotating as the attending physician in the intensive care unit from this year, so he probably doesn’t have much experience either.

“That’s right. That could be the case…… Why didn’t I think of that?”

After heart surgery, the chest tube is often blocked by blood clots and fails to function properly.

In this case, it is often impossible to estimate the amount of bleeding, and tamponade may even progress.

Tamponade.

It means that the heart is compressed and the output is weakened.

From the outside, it may seem like the condition is improving…….

In fact, inside, blood clots are piling up uncontrollably, compressing the heart.

“What was the CVP 1 hour ago? Check the hemoglobin level with ABGA [Arterial Blood Gas Analysis] right now!”

Doctor Ahn Gyeong-sik’s voice becomes urgent.

The languid expression is nowhere to be seen.

He squeezes the line connected to the chest tube and says to Nurse Cha Yu-ri.

“Please prepare an ultrasound, and call for a chest X-ray!”

At the same time, he calls Doctor Ma Dong-seop, who is on backup duty.

This is because in the early stages of a second-year resident becoming an attending physician in the intensive care unit, a senior resident is stationed at the hospital as backup duty.

“Are you busy with something else? He’s not answering the phone……!”

Beep, beep, beep—

Only an empty ringing tone echoes.

Doctor Ma Dong-seop cannot be reached, and Doctor Ahn Gyeong-sik is pacing back and forth.

Next to him, I was carefully watching the patient’s monitoring screen.

Soon, Doctor Ahn Gyeong-sik puts the ultrasound machine on his chest, but his hand movements are unfamiliar.

While he is unable to capture the desired view, a machine for taking chest X-rays arrives at the ICU.

“I’ll take a picture!”

Beep—

A portable X-ray machine that can be checked right there.

Doctor Ahn Gyeong-sik and I looked at the results displayed on the screen.

And, we were speechless at the results before our eyes.

‘……The heart has gotten bigger!’

My guess was correct.

The area around the heart was already full of blood clots, and the white area visible on the X-ray was very large.

The chest tube was blocked, so the amount of bleeding only appeared to be small.

Doctor Ahn Gyeong-sik’s face turned pale.

“S, Seon-han ssaem is right…… The tube isn’t functioning properly. We need to go into the operating room, this patient!”

Ahn Gyeong-sik contacted the operating room and began preparing for emergency surgery.

Right then.

The heart rhythm appearing on the patient’s monitor begins to become irregular.

The blood pressure is also showing a downward curve.

And soon after, the electrocardiogram graph fluctuates in an even more bizarre shape.

“It’s V-fib (Ventricular fibrillation)!”

I was jolted awake by Nurse Cha Yu-ri’s cry.

‘Damn…… It’s flowing exactly the same as that situation I saw in the dream!’

In the dream, Ma Dong-seop said that it started with a ventricular fibrillation event.

The only difference…….

Is that I’m here right now, before going to the operating room.

“Oh, wh, what?!”

Doctor Ahn Gyeong-sik panicked.

Click—

Nurse Cha Yu-ri was already pulling the defibrillator.

“Here you go, doctor!”

Only 5 years of working in the intensive care unit, her past years were not in vain.

With her quick movements, the defibrillator was already prepared next to the patient.

Several other nurses were also flocking to patient Kim Deok-sang’s bed.

Doctor Ahn Gyeong-sik also regained his senses and held the defibrillator paddles in both hands.

“100 joules (J) charge!”

Nurse Cha Yu-ri turns the handle on the defibrillator to 100 and presses the charge button.

The number quickly rises to 100.

“Stand back!”

Bang—

An electric shock is applied to the patient with a force of 100J.

The heart rhythm visible on the electrocardiogram lies flat for a moment, then begins to show its shape again.

However, the patient’s heart rhythm is still irregular and violently fluctuating ventricular fibrillation.

Blood pressure is also not being checked.

“200 joules (J) charge!”

Bang—

This time, a shock of 200J is applied.

In an instant, the electrocardiogram on the patient’s monitor distorts and seems to disappear, then draws the heart rhythm again.

“Did it come back……?”

Everyone holds their breath and focuses on the electrocardiogram waveform appearing on the patient’s monitor.

Fortunately, it shows a normal rhythm.

However, it was only for a moment.

The heart rhythm seems to return to normal for a moment, but then it gradually becomes irregular again.

‘There are a lot of hematomas near the heart, so unless these are fundamentally resolved, the patient can’t get better!’

Doctor Ahn Gyeong-sik’s thoughts would have been the same as mine.

“We need to go into the operating room! Seon-han ssaem, call the anesthesiology department right now and tell them we need to go into emergency surgery!”

In the meantime, the patient falls into ventricular fibrillation again.

“It’s V-fib (Ventricular fibrillation) again!”

Since the heart is trembling, the blood pressure is naturally not being captured.

“Charge 200 joules (J) again!”

Doctor Ahn Gyeong-sik performs defibrillation (shock) once again.

At the boundary between life and death for patient Kim Deok-sang, the cardiac surgery intensive care unit began to get busy.

I tried to turn the steering wheel, but the car that had already left the guardrail was rushing to the edge of the cliff.