Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 68

#68 Isn’t Thoracic Surgery a First? (16)

Starting the intubation, Ryu Myeong-in said,

“Hyung, please squeeze the ambu bag.”

“Got it.”

While Ryu Myeong-in gripped the mask and fitted it, I squeezed the ambu bag next to him.

Shuuk— Shuuk—

Phlegm mixed with blood gurgled messily from the patient’s mouth, in rhythm with the squeezing of the ambu bag.

Even with this much oxygen being pumped in, the patient’s oxygen saturation only hovered around 90.

An unsatisfactory level.

“Laryngoscope, please.”

Ryu Myeong-in said.

There was tension in his voice now.

Ryu Myeong-in removed the mask from the patient’s face and tried to insert the tube, tilting the patient’s mouth back.

I handed him the suction device and simultaneously pressed around the vocal cords to help Ryu Myeong-in.

‘Wait. But…….’

Suddenly, I noticed something peculiar about the patient’s body.

The lower jaw is very short.

Is the length from the thyroid cartilage to the tip of the chin even two finger widths?

Even though Ryu Myeong-in tilted the patient’s chin back as far as possible, that was all it would go.

Only then did I realize.

‘So that’s why Ma Dong-seop said it was a difficult airway in my dream!’

A physique like a wrestler.

A thick, short neck.

A typical appearance of a patient with a ‘difficult airway’ that I learned about back in school.

In other words, it means the intubation difficulty is high.

Moreover, the inside of the mouth and throat, filled with hemoptysis [coughing up blood], would obviously have poor visibility.

‘Damn it, why give me such a high-difficulty mission from the start?’

However, Ryu Myeong-in’s movements were unhesitating.

Swoosh—

He inserted the e-tube (endotracheal tube) into the throat without hesitation.

I asked from the side.

“Did you see the epiglottis and vocal cords well?”

I asked if the structures that were like milestones for intubation were clearly visible, and Ryu Myeong-in’s answer was full of confidence.

“Of course.”

“Are you sure?”

“Hyung. We’re saving a patient here, why are you making me anxious from the side? You have so little faith in your colleague.”

Right. I have to trust you.

He’s not just an ordinary intern, but the top of his class at Yonsei University.

But, I saw the future!

The future where you fail and become a loser, wailing.

For now, I have no choice but to do my best to help prevent that future from happening.

“Okay, done!”

Soon, the intubation was over.

Ryu Myeong-in is fast, as expected.

In the meantime, I assisted with the procedure and examined every step.

Even from the side, there didn’t seem to be any major mistakes.

Shuuk— Shuuk—

Oxygen begins to be supplied through the tube inserted into the patient’s mouth.

But…….

Something is strange.

Even though oxygen is being continuously supplied, the patient’s saturation (oxygen level) is not rising.

76—

74—

72—

“What’s going on? The oxygen level is dropping instead.”

“Just a moment.”

Ryu Myeong-in frowned.

Something’s wrong.

Something went wrong.

That’s what everyone was thinking.

Paat—

The waveform on the saturation check machine disappeared, and the numbers showing the oxygen level suddenly vanished.

“……!!”

Everyone was horrified.

“Doctor, the wave is gone!”

The nurse watching cried urgently.

If there is no wave, saturation is not recorded.

Usually, in this case, you would change the finger to which the machine is attached.

Of course, it would be fortunate if the saturation reappeared by doing so…….

But what if it’s because the oxygen inside the patient’s body is running out?

“Something’s wrong! Why isn’t the saturation showing up?”

The nurse is moving urgently, trying to attach the saturation check band to a different finger.

There is no time to think.

I quickly took out the stethoscope from my pocket.

Stethoscope.

The doctor’s representative symbol.

Of course, it is not used much during internship.

So it’s almost like a decoration stuck in a pocket, and there are many cases where they don’t even carry it around.

But, it is absolutely necessary now.

This is because the first thing to do after performing intubation is to check whether the e-tube has been properly inserted through auscultation [listening with a stethoscope].

“Everyone, just a moment.”

I quieted the surroundings and started auscultation.

Soon, Ryu Myeong-in also took out his stethoscope and placed it on the patient’s lungs and abdomen.

“…….”

We focused our senses.

Beep, beep—

Shuuk, shuuk—

Auscultation is not easy due to the various alarm sounds echoing in the treatment room and the noise heard every time the ambu bag is pressed.

But…….

In the meantime, I can clearly hear the sound of air from inside the patient’s body.

It sounded like the sound of air entering the stomach was in sync with the speed of squeezing the ambu bag.

I said to Ryu Myeong-in.

“This is strange, isn’t it? I can hear the sound well in the stomach too. Rather, it’s ambiguous in both lungs.”

“What are you talking about…… Are you saying I did an esophageal intubation? There’s no way.”

Esophageal intubation.

A medical term used among doctors to refer to the case of intubating the esophagus (食道) instead of the trachea (氣道) [inserting the tube into the food pipe instead of the windpipe].

In other words, oxygen should be entering the lungs, but instead, it is entering the stomach (胃) through the esophagus!

It can be considered the most disastrous result of intubation.

If not corrected quickly, the patient’s organs will suffer serious damage due to oxygen deprivation.

“The patient’s oxygen level isn’t rising either…… This is strange. Shouldn’t we do the intubation again?!”

“The saturation wave hasn’t come back yet, so wait a little longer. We also did a CPR broadcast. We can wait for the resident doctors to come while squeezing the ambu bag.”

Ryu Myeong-in says.

He seems confident that he couldn’t have made a mistake.

But, his voice is shaking.

Can I really trust his judgment right now?

……No.

That is confidence to hide anxiety.

Ryu Myeong-in is afraid to face his mistakes.

He wants to believe that he couldn’t possibly be lacking.

He is trapped in the typical trap of , which people full of confidence tend to fall into [cognitive bias], without realizing it, he is not seeing the situation objectively and is thinking in a way that is favorable to himself.

‘Of course, I’m not sure either. Did I do the auscultation properly? Maybe I’ll end up removing a well-done intubation…….’

At that time.

The phrase Ma Dong-seop told me when he was doing the intubation flashed through my mind.

If I hesitate now, there may be irreversible consequences.

“Ryu Myeong-in, take out what’s in there now and do it again.”

I said firmly.

The patient’s saturation continued to not be measured.

The blood pressure machine, which was being automatically measured every 2 minutes, showed a number of 81/50.

Blood pressure is low.

The patient’s lips were also turning blue. This means that oxygen is not being supplied.

It was clear that if he insisted on this, the patient would fall into a CPR situation.

“Quickly!”

“Okay.”

Ryu Myeong-in answered, suppressing his anger.

I removed the plaster (medical tape) that was holding the patient’s e-tube in place.

Then, I pulled out the e-tube, put an oral airway in his mouth, and started squeezing the ambu bag again.

Shuuk, shuuk—

How long has it been?

The nurse shouts with wide eyes.

“Saturation is back!”

Hoo.

I’ve taken a breather for now.

But it’s not over yet.

The patient’s oxygen level is not sufficient.

Due to the hemoptysis in his throat, oxygen cannot be supplied sufficiently by squeezing the ambu bag like this.

Proper intubation is absolutely necessary.

“Ryu Myeong-in. You have to do the intubation again. Can you do it?”

“…….”

Ryu Myeong-in’s face is pale.

It’s understandable.

Because he has no choice but to admit that he made a mistake.

If he hadn’t done as I said, he could have put the patient in danger.

“If you can’t do it, I’ll do it.”

“No, I can do it!”

He bit his lip.

Then, he started intubation again and muttered.

“I made a mistake once, so I shouldn’t make the same mistake again.”

I nodded.

As long as it is something that people do, trial and error always follows.

And Ryu Myeong-in just experienced that trial and error once.

So, this time he will get the right answer.

I believe he has that much talent.

Right now, Ryu Myeong-in is still the most likely to succeed in intubation in this place.

“Suction.”

Ryu Myeong-in’s voice becomes calm.

I started assisting again.

He lifted the patient’s mouth with a laryngoscope.

“Hyung, press the cartilage and hold the chin.”

Our breathing was better matched the second time than the first time.

Ryu Myeong-in looked at the patient’s airway with a more cautious look.

Then he widened his eyes.

It’s an expression that he saw something for sure.

Soon he inserted the tube without hesitation.

“Hyung, I put it in.”

“Are you sure?”

“I’m sure this time. I definitely looked and put it inside the vocal cords.”

We started auscultation.

It’s a tense moment.

The surrounding nurses also stop all words and actions for a moment and focus on us.

Saeak— Saeak—

This time, the sound was clear in both lungs!

The sound coming from the stomach was also completely different.

Before, it was ambiguous and uncertain, but now I could be sure.

That air is entering the patient’s lungs.

The oxygen level was also rising.

“Hoo woo.”

I sighed in relief.

Ryu Myeong-in also checked the auscultation and his expression finally brightened.

“Hyung’s judgment was right. I intubated the esophagus…….”

“Don’t blame yourself too much. It was obvious that it was a patient with a difficult airway. It would have been difficult for anyone else to come.”

I comforted him.

It’s not just empty words.

Self-objectification is not easy.

Especially in a rapidly changing situation.

That’s why I volunteered to be the observer.

Thanks to this, I was able to catch Ryu Myeong-in’s mistake in time.

The expression of the guy who was blaming himself brightened a little at my consolation.

“Hyung.”

“Why?”

“High five.”

He holds out his hand.

I chuckled and lightly slapped the hand he held out.

Jjak—

It’s almost like the last scene of Slam Dunk’s Sanwang game [a famous basketball manga series].

I can’t believe I’m going to high-five with this guy.

It’s something I would never have imagined normally.

“Still, I solved it well, right? It seems like no intern can do such a difficult intubation.”

“Yeah, you did a good job.”

“Well, hyung’s assist was pretty good too.”

Ryu Myeong-in’s boastful tone returned to normal.

I would have hated it normally, but now it’s just funny.

That’s how good I felt too.

“Don’t let your guard down yet and let’s start with suction. The patient’s throat is full of hemoptysis, so it will be difficult to breathe.”

“Of course.”

Ryu Myeong-in focused on the patient again at my words and started suction.

After checking that the oxygen level was rising for about a minute, I was relieved.

Ryu Myeong-in’s eyes widened as he suctioned through the e-tube.

“Wait. Seon-han hyung. This…….”

Gush—

Suddenly, a large amount of blood came up through the tube.

Soon, the oxygen level started to drop again!

“Saturation is 73 again!”

Damn it!

What is this?

The problem was clearly solved.

What’s wrong this time?

I thought the rough storm had passed, but this time the water is rising at the bottom of the ship.

Was it difficult with just two junior sailors after all?