Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 213

#213 Hawk Eyes, a Woman’s Hands, a Lion’s Heart (16)

“?!”

We, watching the surgery on the screen, were startled.

Could something have gone wrong?

A drop of blood spurts from the baby’s aorta, leaving a clear mark on the lens of the first assistant, Professor Heo Jun-im’s glasses.

“Oh, Professor Heo Jun-im got blood on his glasses. What should we do…? I hope nothing went wrong?”

Shin Sang-mi makes a fuss and worries, but Ma Dong-seop answers calmly.

“During Aorta cannulation [inserting a tube into the aorta], blood can splatter that high. The aorta has the highest pressure in our body.”

It’s a common occurrence, he explains.

As he said, the White Knight [referring to Baek Yi-sin] didn’t seem to care at all that blood had splattered on him.

Not a twitch in his facial muscles.

He’s just blocking the aorta where the blood splattered with his finger.

Soon, he holds out his right hand to the surgical nurse and says quietly.

“Cannula.”

He slightly removes his finger and pushes the cannula he received into the aorta.

Swoosh-

The cannula goes smoothly into the aorta.

At the same time, Heo Jun-im secures the cannula with one of the two layers of thread he has prepared.

Click-

Heo Jun-im uses a mosquito (a hemostatic surgical instrument) to secure the thread, and the White Knight immediately secures the next cannula.

Click-

As if they had been practicing together for years, the two men’s hands move like flowing water.

“Wow…”

“So fast…”

We, the prospective first-year residents, were staring blankly.

Professor Baek Yi-sin is amazing, but Professor Heo Jun-im is also no less impressive.

It’s like watching a perfectly synchronized knife dance.

The relationship between the surgeon and the assistant.

It was a moment to realize once again that the two are inseparable.

No conversation was needed between the two.

They knew what to do at this moment and just moved accordingly, as if acting with a pre-arranged script.

Tap, tap-

Baek Yi-sin taps the cannula from the bottom up with a clamp forcep (surgical instrument).

Then Shin Sang-mi’s question follows.

“What is that for?”

“The cardiopulmonary machine [heart-lung machine] will pump blood into our body through the cannula that just went into the aorta.”

“Yes, and?”

“So there shouldn’t be any air bubbles in there. If air bubbles accidentally fly to the head, it can cause cerebral embolism [blockage of a blood vessel in the brain].”

Ma Dong-seop’s terrifying explanation.

I added a question.

“Air embolism. So, is that the process of shaking off and blowing away those air bubbles now?”

“That’s right. That one small air bubble can kill the patient.”

I understood and nodded.

The process of the patient’s blood getting oxygen from the heart-lung machine and entering the aorta.

If there is even a small impurity in that process, it can kill the patient.

Even if it’s just a small air bubble.

That’s how heart surgery is a moment-by-moment matter of life and death.

As Heo Jun-im connects the cannula he just put into the aorta to the tube coming out of the heart-lung machine, Ma Dong-seop explains.

“Even that kind of process seems like nothing, but there are principles.”

“Isn’t it just fixing and connecting it?”

“No, that cannula also has a direction, so you can’t just fix it recklessly. The knob on the side must face downwards.”

“Wow, details…”

Shin Sang-mi makes a dizzy expression.

“The initial routine process of heart surgery is not easy. If you don’t know it properly, you won’t even have a chance, so watch carefully. How Heo Jun-im and Yoo-joo are doing…”

Ma Dong-seop explained many things to us after that.

The roles of the second assistant, the first assistant, and the surgeon.

About what each person should do in the cannulation process.

‘Let’s remember it well.’

I refocused my concentration.

A surgery where the patient’s life is at stake.

Every minute and every second is a moment of learning.

I think I know why Professor Baek Yi-sin insisted on the live broadcast.

Learning is like planting a plant.

If knowledge is a seed, it only takes root through experience.

What we are doing now is a kind of indirect experience.

Compared to simply learning knowledge from books, watching surgery in real time was a different quality of experience.

“Okay, cannulation is coming to an end. Focus on the screen again!”

Ma Dong-seop pointed to the screen.

Professor Baek Yi-sin had already completed the work on the superior vena cava (SVC) and inferior vena cava (IVC) [major veins returning blood to the heart].

Now it’s time for the heart-lung machine to work.

Professors Heo Jun-im and Song Yoo-joo’s hands also moved busily.

“Dr. Song Yoo-joo is doing well, right?”

“Of course. Who is Song Yoo-joo?”

That’s a relief.

The tense look from the previous day cannot be found on Song Yoo-joo’s face.

A truly exemplary second assistant who exists like a shadow in the field.

Soon, as the cannula is connected to the heart-lung machine, Baek Yi-sin shouts as he releases the clamp.

“Pump ON!”

Pump.

A simplified name for the artificial heart-lung machine.

With Baek Yi-sin’s cry, extracorporeal circulation [circulation outside the body] through the artificial heart-lung machine began.

A ‘bypass’ was created, in which blood was drawn from the superior and inferior vena cava, the path through which blood returns to the heart, oxygenated in the heart-lung machine, and returned to the aorta.

Whirr-

The pump of the artificial heart-lung machine began to turn quietly.

Were there any problems in the whole process?

A moment of tension flows, and soon the perfusionist [specialist operating the heart-lung machine] in front of it shouts.

“Pump running at 100%!”

This means that extracorporeal circulation through the heart-lung machine has been perfectly implemented.

Then Baek Yi-sin immediately shouts in succession.

“Ventilator OFF!”

Patient Lee Seul-gi, who had been breathing while relying on a ventilator after anesthesia.

In a normal situation, stopping the ventilator could lead to death.

However, now the artificial heart-lung machine is replacing the functions of the heart and lungs.

The ventilator is no longer needed.

At this time, a middle-aged man watching from the diagonal direction in the auditorium glances at his cell phone and says.

“22 minutes to pump on… Baek Yi-sin is alive. Hehehe.”

It was a soliloquy, but it was loud enough for a few people around to hear.

‘Who is it?’

I glanced at him.

Was he about the same age as Professor Baek Yi-sin?

He had the air of a professor, dressed in a suit with suspenders.

He was short, but had a very passionate impression.

Seeing this, Ma Dong-seop said.

“That’s Professor Wang Seong-han of pediatric cardiology at Daeil University…”

“Oh, isn’t he famous? I think I’ve heard of him too.”

“I know him. Isn’t he the author of the textbook on cardiac surgery?”

As Ryu Myung-in pretended to know him, Ma Dong-seop nodded.

“That’s right. He is one of the leading authorities in this field. He must have come to see Professor Baek Yi-sin’s surgery.”

It was a moment when I realized that the entire thoracic surgery field in Korea was watching this surgery.

“But is 22 minutes to pump on fast?”

“It’s amazing to do it in 22 minutes even after partial dissection of the pulmonary artery. For reference, it takes me over an hour.”

“Wow…”

“Actually, I can’t believe it either while watching.”

Ma Dong-seop let out a hollow laugh as if he was dumbfounded, then added.

“All the stories I’ve heard so far were nonsense. Professor Baek seems to have definitely returned.”

He can’t do surgery.

His skills are dead.

et cetera [and so on].

The rumors about Baek Yi-sin were gradually being revealed to be false.

In fact, even some critical professors are now slowly withdrawing their suspicious eyes and focusing on the screen.

As people working in the same field, they couldn’t help but respect him.

Although opinions are divided, he was an undeniable figure in terms of skill.

At this time, Professor Baek Yi-sin’s microphone was turned on again in the operating room.

“Now, with the pump on, the surgery will proceed with Moderate Hypothermia [cooling the body]. Please set the body temperature to 23-24 degrees.”

A dry voice announces the next step in the surgery.

Moderate hypothermia.

It refers to maintaining hypothermia during heart surgery.

“Are you lowering the body temperature to 24 degrees?”

“That’s right. When the body temperature drops, the oxygen consumption of our body decreases. You can think of oxygen consumption as decreasing by almost half for every 10 degrees [Celsius].”

Ma Dong-seop explained, writing on paper.

All organs in our body are damaged if the oxygen demand and supply are unbalanced.

This imbalance is easy to be exposed to during heart surgery.

However, if the heart-lung machine is used too excessively to increase oxygen supply, various complications can occur.

So, by lowering the body temperature itself, the oxygen demand of our body itself is lowered.

“Hypothermia protects various organs during heart surgery.”

“Wow, just lowering the body temperature does that?”

“Of course. For example, the brain.”

“The brain too?”

Shin Sang-mi’s eyes widened.

It’s understandable to be surprised.

The brain is the most vulnerable tissue to ischemic conditions [lack of blood supply].

It is common sense that it is fatal even if oxygen does not go to the head for a short time.

I recalled what I had studied in the book until recently and added an explanation.

“I heard that even if no blood goes to our brain, we can withstand 20 minutes in moderate hypothermia.”

“Huh? Then does that mean you can wake up without any problems even if blood doesn’t go to your head during that time?”

In response to Shin Sang-mi’s question, Ma Dong-seop nodded as if to confirm my words.

“Yes, Seon-han is right. Even if you lower it to 18 degrees, you can withstand it for up to 45 minutes.”

“Wow… is that literally coming back from the dead?”

“You can say that.”

Coming back from the dead.

It’s by no means a wrong expression.

The process of a person dying is often expressed as ‘crossing the river’.

Sando River in the East, Styx River in the West, etc…

If you apply that mythical expression, the patient undergoing heart surgery actually gets into the river.

Of course, even in the meantime, the body is tied to a rope and connected to this world.

It is the doctors participating in heart surgery who are holding the rope at the end.

“Ugh, goosebumps. So cool. So thrilling. I’m glad I came to thoracic surgery.”

As Shin Sang-mi stroked her arm and exclaimed, Ryu Myung-in pouted her lips.

“I thought you hated thoracic surgery?”

“Ahem, ahem. When did I say that? She’s saying all sorts of things while the chief is listening.”

“You clearly said you’d run away if things went wrong last time…”

“Oh my, mosquitoes in this season!”

Shin Sang-mi slapped Ryu Myung-in’s babbling mouth so hard that it made a sound.

Certainly, the world of heart surgery was so attractive that even Shin Sang-mi fell for it.

Moreover, pediatric heart surgery.

A scene where all the medical knowledge that mankind has accumulated is mobilized to save the life of a small baby.

There was an indescribable emotion in that operating room right now.

“Hehe, after all, the reason I came to thoracic surgery is because it’s a divine revelation that a genius like me should do this…”

Ignoring Ryu Myung-in’s nonsense muttering with her reddened mouth, Ma Dong-seop continued.

“Okay, now it’s time for the heart to stop.”

“The heart will stop completely? Not just emptying the heart and operating?”

“Now watch. That process will begin.”

We focused on the screen.

Swish, swish-

Baek Yi-sin starts purse string suture [a type of stitch] once again, right below the aortic cannula he just connected.

Then he inserts another thin tube into the aorta.

“It’s a tube (cannula) for administering something that can be said to be the core of heart surgery. Anyone want to guess what will go in there?”

“Cardioplegic solution [a solution used to stop the heart].”

“Oh, you’re right.”

Ma Dong-seop was surprised and pleased by my unwavering answer.

“Seon-han seems to have studied a bit? Professor Heo Jun-im said. The key to heart surgery is Myocardial protection [protecting the heart muscle].”

The surgery was entering a deeper and more profound stage, step by step.

At that time, Baek Yi-sin in the screen raised his head and shouted.