Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 214

#214 Hawk Eyes, Woman’s Hands, Lion’s Heart (17)

Clatter-

As soon as the White Knight finished speaking, he clamped Slgi’s entire aorta with thick clamp forceps.

ACC (Aortic Cross Clamp).

This refers to clamping the aorta to completely ‘disconnect’ the heart from the aorta.

This means that from now on, he will separate the heart to examine it more closely.

Whoosh-

At the White Knight’s command, ‘cardioplegia’ began to flow into the aorta.

This technique involved using the complete blockage from the aortic cross-clamp (ACC) to send cardioplegia into the coronary arteries.

The fluid, entering the coronary arteries responsible for the heart’s blood supply, is delivered to the heart muscle.

“Now, watch what happens to the heart.”

“Yes.”

At Dr. Ma’s words, we swallowed hard and watched the process.

The cold ‘cardioplegia’ at 4℃ spreads throughout the heart.

As it did, the heart began to turn pale, and its movements gradually slowed.

Thud-

Soon, the heart muscle reaches a point where it no longer beats.

“Wow, the heart… it looks like it’s frozen.”

Dr. Shin nodded at Shin Sangmi’s exclamation.

“That’s what happens when cardioplegia containing potassium (K) is introduced.”

“Potassium is a drug that needs to be used very carefully, right? If injected incorrectly, the patient’s heart could stop.”

“We’re using that aspect. If used well, it’s a medicine; if used poorly, it’s a poison.”

In other words, it’s like intentionally stopping the heart temporarily using medication.

“But does doing this protect the heart muscle?”

“It does.”

Dr. Ma nodded.

Myocardial protection.

As the name suggests, this is a crucial step in protecting the heart muscle during surgery.

It involves temporarily stopping the heart so that the heart muscles, which are not receiving blood flow during the surgery, are not damaged.

What if the heart muscles are damaged?

The patient may not recover heart function after the surgery.

That means death.

“Wow, how many life-threatening moments do you have to go through to get heart surgery?”

“Such heart surgeries are performed without problems hundreds of times a day worldwide, which shows the advancement of modern medicine…”

As we were talking in hushed tones.

Thump-

The door at the back of the auditorium opened.

We all turned around at once.

Through the closing door, the back of a woman was disappearing as if fleeing.

“Who is it?”

“The back looks like a guardian…”

“Oh, the baby’s mother?”

“I almost forgot, but she was watching the surgery from the back row until just now.”

“Ah…”

Shin Sangmi made a face as if she had bitten her tongue.

She seemed sorry for having been so excited just a moment ago.

“Even for someone with a strong heart, watching their child’s heart surgery must have been difficult…”

Dr. Ma trailed off, looking troubled.

Only then did I snap out of it.

At some point, we were talking as if we were studying.

We are prospective first-year residents with a duty to ‘learn’.

It would be dereliction of duty not to learn enthusiastically during such an opportunity.

‘…But from the guardian’s perspective, it would be completely different.’

The surgery of a precious baby.

The fact that so many doctors are coldly studying and researching it.

I understand it in my head, but my heart can’t bear it.

Every patient is a ‘case,’ but at the same time, they are someone’s precious family.

‘Let’s not forget.’

I looked at the door where the guardian had disappeared and engraved it in my heart.

Each surgery.

It may be a process of gaining experience for doctors, but it is a once-in-a-lifetime event for them.

‘Don’t worry. Slgi will definitely come back alive!’

The guardian trusted the doctors and mustered courage.

She agreed to the first surgery of its kind in Korea and to the live surgery for academic purposes.

As such, the doctors in the operating room are doing their best.

‘I hope Slgi can come back from the brink of death.’

I earnestly hoped and prayed.

* * *

Meanwhile, in operating room 17.

Song Yoozoo let out a soft breath under her mask.

‘Hoo.’

Her legs were stiff.

But there’s no time to stretch them.

Even a slight movement of the body could cause her hand to shake minutely, hindering the surgery.

The speed of the surgical field was increasing with time.

Thanks to that, the tension in her heart had long disappeared.

‘…Dr. Baek’s speed is so fast that just keeping up is overwhelming.’

Song Yoozoo refocused her concentration.

The fact that the surgery could proceed so quickly was largely due to Song Yoozoo’s contribution.

The more glamorous the stage, the more effort is required behind the scenes.

Her role now was like that.

‘Let’s just stay focused for a few more hours!’

Meanwhile.

The PRT [Pulmonary Root Translocation] surgery was progressing smoothly, step by step.

The White Knight picked up the scalpel.

And began to cut through the right atrium (RA) of the heart.

Swoosh-

As the knife entered, the White Knight’s mouth opened.

“Song Yoozoo.”

“Yes?”

“Tell me what I’m doing now.”

An unexpected question.

As if testing her.

Song Yoozoo blinked a few times and then answered calmly.

“Venting, you’re removing the cardioplegia that’s re-entering the heart.”

As if in response, the White Knight’s suction entered the cut-open right atrium.

And through the hole between the atria, it also entered the left atrium to remove the cardioplegia.

“Why do we do venting?”

“If cardioplegia accumulates in the heart and the ventricles expand, it can cause myocardial damage [damage to the heart muscle].”

The White Knight did not answer.

That meant she was correct.

Right now, he was doing everything he could to avoid causing myocardial damage.

Even if he finishes the heart surgery while keeping the myocardium [heart muscle] alive, the patient won’t die.

“Well, it seems like the heart has stopped.”

The White Knight said.

The small heart that had been showing off its vitality until an hour ago.

That heart was now motionless.

All preparations were complete.

Soon, the White Knight speaks into the microphone.

The White Knight’s cold voice echoes through the auditorium.

He had shown to some extent that his hands had not rusted during the cannulation process.

Now it was time to show his skills in earnest.

Everyone watching in the auditorium was waiting for this moment.

The beginning of the full-scale PRT surgery.

The White Knight’s hand moves.

In one hand, forceps.

In the other hand, he alternately holds a bovie (electrocautery) and a metzenbaum (surgical scissors).

Soon, his hand moves like a pianist, beginning to dissect the root of the pulmonary artery.

‘…!’

Song Yoozoo’s eyes widened.

At this moment.

Tiredness and tension had vanished completely.

The same was true for the people in the auditorium, including Shinseonhan.

‘This is…’

You see as much as you know.

Song Yoozoo, who had participated in many surgeries, could instinctively feel it.

That his level was three stages above that of ordinary surgeons.

‘This is Professor Baek’s surgery.’

Fast.

And accurate.

It is said that high-level skill is indistinguishable from art?

Watching his hand movements, it’s like watching an artist who has devoted his soul to sculpture.

An artist freely sculpting a fist-sized child’s heart.

It was close to the ideal that Song Yoozoo had drawn in her mind many times.

‘Someone like that has TOS (Thoracic Outlet Syndrome) [a condition affecting nerves and blood vessels in the space between the collarbone and first rib]?’

That can’t be.

If his hand was tingling due to the illness, it would not have been easy to hold surgical instruments.

It was difficult to have such doubts even after seeing his sharp hand movements directly.

‘Amazing.’

Suddenly, Song Yoozoo recalled an old sentence.

One of the best architects of the 20th century, Ludwig Mies van der Rohe.

When someone asked about the secret to his success, he replied with this clear sentence.

Swish, snip-

The White Knight’s hand did not miss the details.

His metzenbaum digs into some of the myocardium of the left ventricle where the pulmonary artery is located.

Dissection that proceeds with only the necessary force in the necessary areas, even in controlled movements.

With his magical fingertip movements, the root of the pulmonary artery was slowly revealing its appearance.

Soon, his fingertip digs into the left ventricle side.

‘This is the most important part!’

Song Yoozoo thought, focusing on assisting.

‘We need to be careful not to damage the right ventricular branches and the LAD [Left Anterior Descending] coronary artery…’

As expected of Professor Baek.

He avoids the dangerous parts like a ghost without slowing down.

It means that the 3D structure of the heart is perfectly in his head.

‘If I were the surgeon, could I do this?’

Song Yoozoo thought for a moment in her head and quickly came to a conclusion.

Impossible.

Of course, there are many examination methods that can construct the patient’s heart from outside the body.

Echocardiogram.

Cardiac MRI.

Cardiac CT.

However, it is not easy to perfectly construct the patient’s heart structure in 3D with these examination results.

If I don’t know what’s behind this part when I put a knife on a certain part, can I put a knife recklessly?

Therefore, 3D spatial awareness is essential for surgery.

At that time, the perfusionist shouts.

“20 minutes have passed!”

The White Knight answers without stopping his hand.

“I’ll give you cardioplegia one more time.”

Cardioplegia was injected again.

Even while concentrating, the myocardium must be protected periodically.

A figure who does not neglect other aspects that need attention, as well as his hand skills.

The White Knight’s hand continues to move busily.

Before long, the root of the pulmonary artery began to fully reveal its appearance.

‘When I read the paper, there were many structures that I had to be careful not to damage in this part…’

Song Yoozoo focused.

The process of completely removing the root of the pulmonary artery.

In this process, care must be taken not to damage the mitral valve, and the aorta must not be damaged.

And attention must be paid to the direction of the blade.

However, contrary to Song Yoozoo’s thoughts, the White Knight’s fingertip actually speeds up even more.

‘Yes, Professor Baek will do well.’

Snip- snip-

He was carving out the root of the pulmonary artery from Slgi’s heart.

As if creating a sculpture from the heart.

But then.

Suddenly, the White Knight briefly steps away from the field and raises his head stiffly.

Then he tilts his head.

Is there something wrong?

“…Hoo.”

The White Knight takes a short breath.

He, who had never stopped like a runaway train since the surgery began, finally took a comma.

But that point is the most dangerous part of the surgery.

“What’s wrong?”

“Why did he stop?”

The auditorium was also buzzing.

Isn’t his arm tingling?

Or did he cut where he shouldn’t have?!?

Everyone stared at the White Knight’s face with tension.