Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 192

Dr. A Fresh Surgeon of the Future-192 (192/241)

#192 A Fresh Thoracic Surgeon (9)

“200 Joules, charge!”

Nurse Cha Yuri shouts.

Thump!

Ahn Kyung-shik once again presses the paddles to the patient’s chest, delivering the defibrillation.

Thud.

The patient’s body arches in response to the 200-joule shock.

‘The rhythm has to come back!’

If the heart rhythm doesn’t return now, I’ll have to start chest compressions to manually circulate blood throughout the body.

If that happens, will the future I saw even unfold?

I’ve rushed here like this, but nothing might change.

I need to buy time to try something, anything.

‘Please, let the rhythm come back!’

Everyone’s eyes are glued to the EKG waveform on the monitor.

The EKG waveform, which had disappeared briefly with the electric shock, begins to reappear.

“I, I think it’s sinus rhythm (normal heart rhythm)……?!”

Doctor Ahn Kyung-shik says, pushing up his horn-rimmed glasses that had slipped down his nose.

Did my prayers get through?

The patient’s heart rhythm has returned to a normal waveform, for now.

And at that moment, a hospital-wide announcement echoes from the ceiling.

Thoracic surgery team, thoracic surgery team, please come to the cardiac surgery ICU immediately.

It was a CPR [cardiopulmonary resuscitation] broadcast.

It seems one of the ICU nurses quickly requested it.

The voice requesting assistance repeatedly echoes throughout Yeon-guk University Hospital.

‘Since the CPR broadcast went out, someone will come. Doctor Ma Dong-seop must be in the hospital too!’

But I can’t relax yet.

I’ve only put out the immediate fire.

The heart is still under pressure, and although it has returned to a normal rhythm, it could fall back into ventricular fibrillation [a life-threatening arrhythmia] at any moment.

It’s a truly desperate situation.

The patient’s systolic blood pressure is fluctuating between 60 and 70.

The waveform representing arterial pressure on the monitor looks like it could collapse limply at any moment.

“Epinephrine (cardiac stimulant) up to 0.3, please. And get the OR [operating room] ready immediately!”

Ahn Kyung-shik shouts.

As the attending physician, he’s showing as much leadership as he can.

Soon, the nurses begin to move in an orderly fashion.

The patient’s vital sign monitoring lines are moved and plugged into the portable monitoring device attached to the bed.

The medications being administered to the patient are also moved to the IV pole next to the bed.

An oxygen tank and ambu bag [a manual resuscitator] are prepared so the patient can breathe without a ventilator while being transferred to the operating room.

While everyone is busy preparing to enter the OR, the patient’s heart rate begins to slow down little by little.

“Doctor, the EKG (electrocardiogram) is changing!”

I shouted to Doctor Ahn Kyung-shik.

Because the heart rate was slowing down, and strange waveforms were starting to appear.

Ahn Kyung-shik looked like he was about to cry.

“Aish, this is driving me crazy. Why are there so many PVCs (premature ventricular contractions)……?!”

PVC (premature ventricular contraction) means the heart, which used to beat in the order of atria-ventricles, has started beating with only the ventricles going haywire.

It was evidence that the heart was being squeezed by hematomas [a collection of blood outside of blood vessels] and barely holding on with the help of cardiotonic agents, causing it to lose its mind.

With the slowed heart rate and only the ventricles beating erratically, the patient’s blood pressure began to drop again.

Now it’s fluctuating between 50 and 60.

“Doctor Ahn Kyung-shik, with this rhythm and heart rate, the cardiac output seems insufficient!”

“Just a moment, let me think.”

Then, Ahn Kyung-shik’s eyes flashed open, and he shouted.

“G-Give me a pacemaker so we can do pacing!”

The card Ahn Kyung-shik pulled out this time was a pacemaker.

It is an electronic device used to artificially stimulate the heart with electrical pulses.

After heart surgery, thin wires called pacing wires are attached to the atria/ventricles and left in place.

This is to stimulate the weakened heart to beat faster if it beats slowly after heart surgery.

“Please……!”

Doctor Ahn Kyung-shik holds the pacemaker in his hand and changes the settings.

Tick.

Soon, artificial electrical stimulation is applied to patient Kim Deok-sang’s heart, which has a slowed heart rate.

Then, a spike waveform appears on the electrocardiogram, and the heart starts beating faster than before.

“Doctor, the blood pressure is rising!”

As the heart began to beat quickly and regularly, the blood pressure began to rise little by little.

This is something I didn’t see in the dream.

Did I change the future because I arrived earlier, allowing Doctor Ahn Kyung-shik to have some kind of awakening and come up with a new solution?

Anyway, thanks to that, I was able to buy some time.

The car that was running towards the edge of a cliff is now barely holding on with half of its wheels on the ground.

“Is anesthesia ready? This isn’t a situation where we can wait!”

Doctor Ahn Kyung-shik shouts.

Going into the operating room for an emergency is not a simple matter.

Anesthesia personnel and operating room personnel must be prepared.

Of course, right now, we have to ignore those things and push our way into the operating room.

Even so, it seemed like it would take more than 10 minutes to reach the operating room.

‘Did the future change because I ran here, allowing me to react a little earlier?’

I can’t know anything yet.

At that moment.

The EKG waveform starts to change irregularly again.

It hasn’t even been a few minutes since we started using the pacemaker.

“Since there are hematomas all around the heart, I guess the pacemaker isn’t working properly either?”

Along with Doctor Ahn Kyung-shik’s anxious sigh, the patient’s blood pressure drops again.

The systolic blood pressure is barely above 50.

The patient was still on the precarious edge of life and death, and we had to do something with our own hands right now.

“This isn’t going to work. Epi bolus (a single dose of epinephrine administered intravenously)! And I’ll start compressions, so… Doctor Seon-han, squeeze the ambu bag!”

Thud!

Doctor Ahn Kyung-shik lowers the side rail of the bed and places his hands on the patient’s chest.

Compression performed in a CPR situation.

In this situation where the blood pressure is so low, applying chest compressions (external cardiac massage) for basic life support is not a textbook-wrong treatment.

Because we have to supply blood flow and oxygen to the brain and the whole body somehow.

But…….

‘I know the future.’

Hesitation.

I stopped my hand, which was reflexively reaching for the ambu bag according to Ahn Kyung-shik’s words.

Waiting to go to the operating room while doing chest compressions?

This is the wrong choice.

If we go down this path, the patient will end up being driven to the brink of death.

Then, Professor Kim Seong-tak’s voice, which I had heard roughly shouting in my dream, suddenly came to mind.

I should’ve opened him up in the ICU first, or put him on ECMO [extracorporeal membrane oxygenation – a life support machine] if he arrested!

Ahn Kyung-shik’s choice right now is a passive method.

But there is clearly a better option.

Of course, that path is scary, but sometimes you have to make bold choices.

‘Now is not the time to waste time with compressions!’

I said to Doctor Ahn Kyung-shik, who was about to compress the patient’s chest.

“Doctor.”

“Why, why?”

“What if compressions aren’t a good choice right now?”

“What?!”

Ahn Kyung-shik’s expression was utterly dumbfounded.

What do you know?

Even though you’re a year below me?

That expression is revealed without being able to be hidden.

Even though Ahn Kyung-shik is a nice person, this situation might be me crossing the line.

But I explained as calmly as possible.

“Compressions could damage the surgical site, and we don’t know how long it will take to get to the operating room, so…….”

“…….”

“Shouldn’t we solve the root cause?”

At my words, Ahn Kyung-shik’s pupils shook.

Ahn Kyung-shik also knew that the hematoma causing the tamponade [compression of the heart by an accumulation of fluid in the pericardial sac] had to be removed, and that’s why he wanted to move to the operating room quickly.

But he also doesn’t know how long it will take.

He did his best to use defibrillation and a pacemaker, but the next decision was not an easy one.

“B-But the blood pressure is in the 50s right now, what are we going to do if we don’t do compressions? To hold out until we move to the operating room…….”

He is trying to exert leadership, but his usually weak personality is revealed.

He looks like he desperately wants someone to make a decision for him.

Even if that someone is me, a first-year intern.

I said firmly.

“How about opening him up here and removing the hematoma, Doctor?”

“W-What, here?”

Doctor Ahn Kyung-shik was startled.

Making the decision to reopen the chest in the ICU was not an easy decision for him.

Second-year resident.

He probably has no experience reopening a patient who underwent CABG (coronary artery bypass graft) [a procedure to improve blood flow to the heart] in the ICU himself.

But, I have witnessed even worse situations.

At Gokdam Hospital, Doctor Poong did not hesitate to perform a thoracotomy [surgical incision into the chest wall] even in a much more dire emergency room.

“I think that would be best.”

“…….”

“Doctor.”

There is no time.

Even at this moment, the patient’s life is ticking away.

The blood pressure is dropping more and more, and ventricular fibrillation could occur again at any moment.

If we want to prevent the future we saw in the operating room, now is the only time.

Then, Ahn Kyung-shik shouted as if he had made up his mind.

“……Okay. I’ll take responsibility, so let’s open him up here!”

It was unexpected.

It was a more resolute tone than Ahn Kyung-shik’s usual personality.

Of course, even while speaking so boldly, his face was undeniably pale.

“I’ll prepare for the thoracotomy!”

Thump.

Cha Yuri, who had been listening to our conversation, had already brought an emergency resternotomy set and started preparing.

Patient Kim Deok-sang’s space in the ICU instantly transforms into an operating room.

The speed of preparation was incomparable to that of the Gokdam emergency room.

As befits a cardiac surgery ICU where thoracotomies occur frequently, the well-trained nurses complete the preparations in an instant.

Various medications, including calcium, are injected into the patient along with the blood products that arrived in the meantime.

“Sternotomy set, suction, Bovie [electrocautery device], and headlight are all ready!”

Beep, beep.

Fortunately, the patient’s blood pressure is being maintained around 60.

Doctor Ahn Kyung-shik and I tore off the dressing from the surgical site to open the chest and poured povidone iodine solution.

Splash.

Soon, the drape is spread, and Doctor Ahn Kyung-shik stands in the position of the surgeon, and I stand in the position of the assistant.

There is no shout to announce the start of the surgery.

We begin to tear off the surgical staples on the patient’s chest.

“Tear off the bottom with a mosquito forcep [a small hemostat], I’ll tear off the top!”

“Yes!”

Rip.

The surgical staples on the skin are all torn off, and all the threads that had sewn the tissue underneath are cut.

Then, the sternum that I had split open reveals its appearance.

“……!”

How many times do I have to see it to get used to it?

The moment the patient’s body is opened outside the operating room is uniquely nerve-wracking.

Moreover, the healthy sternum that I had opened is already gone.

Six thick wire sutures that reattached the sternum reveal their appearance through the red blood flowing from the reopened chest fat tissue.

Doctor Ahn Kyung-shik’s Adam’s apple also bobs nervously.

“Wire cutter!”

Doctor Ahn Kyung-shik uses all his strength to cut the wire sutures that hold the sternum together.

Clunk.

Clunk.

The touch is not skillful, but I could feel his desperate will to somehow solve this situation with his own hands.

As he was struggling to cut the wires, a large shadow appeared next to him.

“Kyung-shik, I’ll do it!”

The owner of the big shadow shouting next to him was Ma Dong-seop.

It seems he ran after hearing the CPR broadcast echoing in the hospital.

He was sweating profusely on his forehead as if he had run in a hurry.

“Senior!”

Ahn Kyung-shik greeted Ma Dong-seop almost bursting into tears.

Is that the expression a general makes when witnessing the support of friendly forces when surrounded by enemies?

Now that the chief resident has arrived, he was like a relief pitcher to us.