Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 193

Dr. Fresh Surgeon – 193

#193 Fresh Thoracic Surgeon (10)

Ma Dong-seop’s breathing was rough.

He seemed to assess the situation instantly, taking in the patient’s vital signs and chest X-ray images as soon as he arrived.

“I couldn’t answer the phone because I was doing a VAC dressing [Vacuum-Assisted Closure, a therapy to promote wound healing]. Is it tamponade [compression of the heart caused by fluid accumulating in the sac surrounding the heart] due to bleeding?”

“Yes, I think so!”

“Get out of the way! I’ll handle it!”

Ma Dong-seop took the wire cutter from Ahn Gyeong-sik and began removing the steel wires embedded in the sternum.

Tuk―

Tuk―

He cut them relatively easily, displaying Ma Dong-seop’s unique strength.

‘As expected of the chief resident, he’s fast too.’

“Who made this decision?”

“…Dr. Seon-han suggested it, and I agreed we should proceed.”

Answered Dr. Ahn Gyeong-sik.

Dr. Ma Dong-seop trusted our judgment and continued working without saying anything else.

“Ahn Gyeong, go to the other side. Give me something to open this up!”

Ma Dong-seop received the retractor and began to force the sternum open again.

Drrr―

The patient’s chest opened.

It was the moment when the culprits that had driven life to the edge of the cliff were about to be identified.

‘Now that I’ve opened the chest, the future has changed. If I want to save the patient, now is the time!’

Better two than one.

Better three than two.

The situation changed when three thoracic surgeons gathered.

The combination of Chief Ma Dong-seop, Ahn Gyeong-sik, and me.

The surgery on bed number 7 in the ICU was entering a new phase.

“Give me another epi bolus [a single, large dose of medication, usually injected intravenously]!”

Ma Dong-seop shouted, recognizing the blood pressure that had begun to decline again.

And at the same time, he continued to open the sternum with the retractor.

Drrr―

As he turned the handle clockwise, the space between the sternums began to widen little by little, and blood flowed down from the newly opened cross-section of the sternum.

After turning the handle a few times, the inside of patient Kim Deok-sang’s chest began to be visible.

“……!”

The inside I saw was completely different from the thoracic cavity I saw when I opened the sternum this morning.

The chest, which was first opened this morning, had a neat shape with everything in its proper place.

But now, it was different.

‘There’s much more hematoma [a solid swelling of clotted blood within the tissues] than I expected from the X-ray?’

Some of it was still in the form of uncooked blood and was thickly attached near the heart.

Moreover, the patient is a post-CABG [Coronary Artery Bypass Graft] patient.

The internal thoracic artery and great saphenous vein used for coronary artery bypass surgery were showing only a slight glimpse of their appearance, like dragons hidden in the clouds between the blood clots.

“Please turn up the suction power a little more!”

Cheek―

Ma Dong-seop began to remove the hematomas near the heart using gauze and suction.

His hand movements were very careful, as if he might damage the surgical site.

‘If I had pressed hard on his chest like that…’

I could see it clearly without looking.

The patient’s blood vessels, which were sewn with very thin threads, would have been ruined in all likelihood.

“Ahn Gyeong, did you open it right away after you knew there was bleeding and tamponade? Without compression?”

“Yes. I’ve also arranged the operating room!”

“Okay, good job.”

Ma Dong-seop praised briefly.

슥―

As the hematoma was removed, the wriggling internal thoracic artery and great saphenous vein became more visible.

In addition, the threads and knots at the anastomosis [the surgical connection of two blood vessels] site of the blood vessels were gradually revealed.

As he carefully removed the hematomas from every corner around the heart with suction, the vital signs also changed.

“Blood pressure has risen to the late 70s!”

He glanced at the monitor screen where vital signs were being checked, then focused on the field again.

After removing some of the hematomas, he bent the chest tube inside the thoracic cavity and held it with a Kelly clamp, facing the outside of the field.

“Now, let’s find out where the blood is coming from in earnest!”

“Yes.”

He began to look around carefully, and Ahn Gyeong-sik in front of him helped him as much as possible.

I also concentrated and looked around every corner.

But was it because I’m still a first-year resident?

It was hard for me to tell where the surgical field was, and I couldn’t figure out where the bleeding site was.

“It’s not easy…”

Ma Dong-seop also frowned.

It didn’t seem to be found easily.

Even at this moment, blood continued to accumulate around the heart, and the hematoma that had not been completely removed could be seen even below.

Jing―

At that time, the ICU door opened, and the surgical nursing team from the operating room arrived.

“Where should we go? Ah, here it is!”

Looking at the several large and heavy boxes they brought, it seemed that they came prepared with enough surgical instruments.

“Please make some space here!”

One by one, the specialists from the operating room were gathering in the intensive care unit.

The table was quickly unfolded, and surgical instruments popped out.

The operating room nurse now took the place of Cha Yu-ri, the intensive care unit nurse who was helping next to her.

As professional operating room nurses, they delivered the surgical instruments that Ma Dong-seop needed to the right places.

No words were necessary.

It was amazing how they knew what to give him as soon as Ma Dong-seop reached out.

‘I suddenly feel stable.’

It was a moment when I realized the importance of the scrub nurse again.

As he was given more agile instruments than those in the emergency set, Ma Dong-seop’s fingertips also became more nimble.

슥, 스윽―

He removed the remaining hematomas and was narrowing down the candidates for the bleeding site while packing gauze.

At that time, the ICU door opened, and someone hurriedly ran into the intensive care unit.

“What, did an arrest happen?!”

Finally, the final boss.

The end king of specialists, Professor Kim Seong-tak, appeared.

Someone must have contacted the professor about this situation.

In addition to that, there were many thoracic surgeons who had heard the CPR broadcast and rushed to the scene.

After quickly talking to the nurse in charge while looking at the chart, he finished assessing the situation and opened his mouth.

“Good job. It was a very good decision to open the chest right away in the ICU.”

Soon, Professor Kim Seong-tak gowned up and entered the field.

It was the moment when the complete team was completed.

“Gyeong-sik, take care of other ICU patients and solve the many things that are piled up outside!”

Then he pointed to me.

“Seon-han, was it? You just do suction next to me and do what I tell you to do, got it?”

“Yes!”

At this moment.

Bed number 7 in the intensive care unit looked like room number 16 in the operating room I saw in my dream.

Kim Seong-tak, Ma Dong-seop, and the operating room nurse next to him.

The only difference is that I am in the second assistant position.

‘It’s almost here. From now on, just focus on assisting.’

Professor Kim Seong-tak’s headlight pointed to the patient’s heart.

As his fingertips touched every corner of the heart, all the hematomas were removed.

And…….

Finally, the bleeding site revealed itself.

“It’s here,” the professor muttered, his voice tight.

Blood trickled thinly from the proximal end where the internal mammary artery had been detached, like water leaking from a broken faucet.

The patient’s blood pressure plummeted back into the low 60s.

“You did well to hold things down until I arrived. Let’s finish this here without going back to the operating room.”

“Yes, Professor.”

“And the heart is shrunken. We need to give it more volume.”

Professor Kim Seong-tak glanced at the patient’s vitals and ordered an additional blood transfusion.

Then, he grasped a Prolene 8-0 needle with a Castroviejo needle holder (a delicate instrument designed for holding extremely fine sutures).

Ma Dong-seop used a retractor in one hand to improve the field of vision, while his other hand held the back of the thread controlled by Professor Kim Seong-tak.

I focused on removing the flowing blood with suction, trying to make the bleeding site as visible as possible.

‘…….’

My first surgery assisting Professor Kim Seong-tak… I never imagined it would be an emergency procedure in the intensive care unit.

The second assistant’s job seemed simple, but it was anything but. The bleeding site was close to the head, and with Professor Kim Seong-tak and Dr. Ma Dong-seop’s hands and heads constantly moving, my view was obstructed.

However, the second assistant’s primary role is to support the surgeon and the first assistant. I couldn’t exactly ask them to move aside just because they were blocking my view.

‘Where should I position the tip of my suction to best illuminate the surgical field without hindering their movements?’

I examined the surgical field more closely, recalling the surgeries I had observed from the sidelines.

Naturally, Kim Seong-tak, Ma Dong-seop, and I were all intensely focused, a moment demanding extreme concentration from all three of us.

Professor Kim Seong-tak’s needle moved deftly a few times, and then he tied it off.

“Hold this.”

“Yes.”

*Swoosh, snip*— Before I knew it, the bleeding had stopped.

This had to be the touch of a master. I carefully watched the professor’s hand as he meticulously stopped the bleeding.

‘Is the situation finally under control?’

With Professor Kim Seong-tak’s arrival, the surgical field was quickly brought under control. He managed the bleeding, normalized the patient’s vital signs through medication adjustments, and then began to suture the open chest directly.

“Good job.”

The suturing was completed quickly. While the operating room nurses cleaned up the area, the ICU nurses tidied up the disarrayed intensive care unit.

‘I did it.’

Only then did the tension begin to ease. I saved the patient!

Of course, it was too early to celebrate. I had no idea what damage might have been done to the patient during that critical time. There was also the risk of infection, given that the chest wasn’t opened in a completely sterile environment.

But… I felt satisfied, having dramatically steered away from the edge of disaster and changed the course of the future.

It was the first real achievement I had made as a first-year resident in cardiothoracic surgery.

‘The most dangerous moment has passed, so now we just wait for him to recover well in the intensive care unit!’

I looked around with a sense of accomplishment.

Even after the crisis had passed, the intensive care unit remained a hive of activity. Unlike the operating room, which is dedicated to a single patient, the intensive care unit is not.

“Please look at this patient too!”

“Yes, I’ll be right there!”

An Gyeong-sik’s face, strained from managing the backlog of tasks in the intensive care unit, looked almost vacant.

* * *

An Gyeong-sik hadn’t originally applied for cardiothoracic surgery. In fact, there wasn’t any specific department he particularly wanted.

He had been persuaded by a senior resident to apply for plastic surgery, but unexpectedly received an intern score of C and was eliminated.

An Gyeong-sik found himself at a crossroads, unsure whether to enlist in the military or apply for a second-choice residency.

The departments available in the second round were general surgery, cardiothoracic surgery, urology, and obstetrics and gynecology.

Seniors in general surgery and urology, who knew him to be a diligent worker, approached him.

However, he ultimately chose cardiothoracic surgery, drawn by the national subsidy offered to residents in this typically unpopular field.

For his financially struggling family, the subsidy was a significant benefit, and with a desire to become a specialist, he applied for cardiothoracic surgery.

‘Oh, geez… Well, now that I’m here, I’ll dedicate my life to cardiothoracic surgery!’

An Gyeong-sik did his best during his first year of residency. Nevertheless, he was routinely criticized by the professor.

He was often so upset that he would lock himself in the operating room bathroom, sit on the closed toilet lid, and cry.

His greatest wish was to receive praise from the professor, even just once. He never imagined that day would be today.

“Gyeong-sik.”

“Ah, Professor.”

Around the time when patient Kim Deok-sang stabilized and the chest closure was completed, Professor Kim Seong-tak called An Gyeong-sik over.

An Gyeong-sik immediately stood at attention. Given the ICU patient’s earlier deterioration, he feared a reprimand as the attending physician.

However, the professor’s words were unexpected.

“Good job. It was a very good decision to open the chest right away in the ICU.”

“……!”

An Gyeong-sik’s eyes widened. Had he ever been praised by the professor before?

He searched his memory. It seemed to be the first time, except for when he made reservations for after-dinner gatherings following company dinners. He had also been complimented for his karaoke skills.

He never imagined he would receive praise like this at the hospital.

“You rascal, I was worried because you were usually so clumsy, but now you’re starting to look like a real second-year TS [Thoracic Surgery resident]! You saved the patient.”

*Tap tap*— The professor took off his surgical gown and patted An Gyeong-sik’s shoulder as if he were proud.

It was a stark contrast to his daily life of being scolded.

‘I’m being praised by the professor…….’

However, An Gyeong-sik’s expression soon became complicated. He should have been happy, as this was something he had longed for, but his heart wasn’t at ease.

‘If Seon-han wasn’t there… would I have been able to make such a bold decision?’

Suddenly, he felt a sense of burden. Until last year, it had been manageable. As a first-year resident, he could blend in. But now, as a second-year resident in charge of the intensive care unit, his sense of responsibility had increased.

A person’s life could hang in the balance depending on his momentary decisions.

The fears he had been trying to ignore began to surface from the darkness.

‘Can I continue down this path?’

Two hours later, the intensive care unit, which had been in such chaos, had stabilized as if nothing had happened.

The intensive care unit at 1 a.m. was quiet.

‘Oh, I’m exhausted.’

An Gyeong-sik, after checking on the patients one by one, shuffled toward the on-call room.

*Shuffle shuffle*— As he headed to the on-call room with his weary body, he checked the accumulated text messages on his phone.

“……Huh?”

There was an unexpected text message on his smartphone.