Fifth Vital [EN]: Chapter 107

Episode 107. Highly Dangerous Leftovers

“Hngh!”

At the sound, Tae-kyung’s eyes darted left and right, and the others also turned their heads to check each other.

It wasn’t Ui-jin, Lim Jeong-suk, or the assistant nurse.

“Ahem!”

The person who was sobbing, slightly inhaling through their nose inside the mask, was surprisingly Choi Mona, the head of Byeongneung.

Everyone in the operating room except Tae-kyung wore quite bewildered expressions at the unexpected person’s sobbing.

“Ha! I’m sorry.”

Choi Mona quickly apologized, realizing that she was the center of attention and that her current behavior was disrupting the surgery.

“Choi Mona?”

“I’m really sorry, Doctor. I know I’m making everyone uncomfortable. I don’t even know why I’m doing this.”

It wasn’t just an empty apology. Choi Mona genuinely didn’t know why she was acting like such a fool.

Normally, she would have been eagerly observing Tae-kyung’s skills during the surgery.

She would have been even more eager to participate, feeling envious and resentful of Lee Chan-hee, who had participated in more surgeries so far.

But this time, it wasn’t like that. There was no grand or significant reason whatsoever.

She had simply volunteered as an assistant, wanting to be of some small help to that small, fragile child who had been abused. But she didn’t know why she was suddenly crying.

She just felt heartbroken.

Her heart ached so much because of that child who had endured such terrible times.

Choi Mona, experiencing such emotions for the first time, was surprised and embarrassed by herself. But perhaps it was a natural change.

The things she had reluctantly started doing at Tae-kyung’s direction were causing changes in the stubborn head of Byeongneung.

The child and elderly patients she had been treating every day. And Woo-jin, who always laughed and claimed to be the first Choi Mona fan club in our hospital. The little child who received treatment for burns late at night. And finally, Se-young, who had been abused.

Gradually, like clothes getting wet in a drizzle, her hard heart was crumbling without her even realizing it.

“Ha!”

Choi Mona briefly turned around, let out a short breath inside her mask, and calmed her mind.

“Choi Mona.”

“I’m sorry, Doctor.”

“What are you sorry for?”

“Excuse me?”

“It’s nothing to be sorry about, so don’t apologize anymore.”

Tae-kyung, who knew better than anyone the positive changes that had taken root in Choi Mona, encouraged her rather than scolding her.

“Are you calm now?”

“Yes, Doctor. I’m calm now.”

“Let’s start the surgery. Drape, please.”

Tae-kyung received the surgical drape and aseptically placed it around the child’s abdomen.

“Scalpel, please. Dr. Choi, gently press down here below the navel.”

“Yes, Doctor.”

Choi Mona gently pressed down on the skin below the child’s navel to flatten it. Soon after, Tae-kyung made a small incision in the skin with the scalpel in his hand.

“Bovie [electrocautery], please.”

Next, he used the Bovie he received to gradually separate the fat layer inside the abdomen, revealing the fascia layer.

“Mosquito [a scissor-shaped instrument with curved, blunt tips for grasping] and Kelly [similar in shape to a mosquito but more than twice as large], please.”

Tae-kyung used the instruments to grasp the fascia layer and spread it open with the Kelly, creating an opening.

“Trocar [a channel-forming instrument used to secure the abdominal wall so that instruments can pass through during laparoscopic surgery], please.”

Tae-kyung, holding the pierced fascia with the Kelly, inserted the trocar into the opening of the fascia. The trocar is a long instrument that acts as a channel, with a slightly pointed end to pierce the fascia.

Since it was a child, the back wall of the abdomen could be reached quickly, so Tae-kyung carefully inserted it. If it were to touch the back wall and damage a large blood vessel, it could immediately lead to a major accident and instant death.

“Okay, let’s insert the camera.”

A camera, the length of an adult’s hand to elbow, was inserted into the child’s abdomen through the trocar, which had an entrance of about 1 cm.

“Reduce the CO2 pressure to less than that of an adult. It’s too high right now.”

Tae-kyung tapped the child’s abdomen while speaking, and then installed two more trocars in the child’s lower abdomen to proceed with the surgery.

“Grasper [a long instrument that can pass through a 5mm diameter trocar hole, with a clamp at the end], please. Underneath, so the wires don’t get tangled.”

“Shall I give you a dissector [similar in structure to a grasper, but with a Kelly-like clamp at the end, making it easy to separate tissues]?”

“Yes, please.”

Tae-kyung received the instrument, and Choi Mona held the trocar so that he could insert the end of the instrument well.

As soon as they went inside, the small intestines at the top appeared neatly.

Looking at the small intestine of a child, it is truly transparent and clear. Unlike adults, it is not cloudy or murky, and sometimes you could see what was passing through it.

Tae-kyung grabbed the small intestine with the grasper and moved it towards the child’s upper abdomen. As he moved them one by one, the right colon appeared.

The appendix was attached like a tail to the area where the colon began.

‘The smell is awful.’

At the same time as the appendix was revealed, the concentration of the third-stage fecal odor that had spread throughout the operating room instantly amplified and became more intensely pungent.

It felt like the smell was flying around in the air more intensely today.

“You’re the problem.”

This appendix was the problem, but it was now so deformed by inflammation that it was impossible to recognize its original form.

“You’re really a xxxx.”

Seeing the severity of the condition, Tae-kyung, who didn’t usually swear, uttered a truly vulgar curse.

“That’s right, xxx. You deserve to be cursed.”

The medical staff, knowing that the arrow of that curse was directed at Do Han-yeon, each took over the curse in a small voice, as if in a relay.

While profanity was rampant for a while, Tae-kyung was still focused on the appendix.

Fortunately, the appendix was on the front of the colon.

‘It’s a relief it’s in the front.’

If it were on the back of the colon, he would have to lift part of the colon, but in such cases of severe inflammation, it was often fixed to the abdominal wall.

“Then there’s no need to dissect it with difficulty. Because the inflammation is so severe, I’ll cut the appendix and the end of the colon at the same time and take them out. GI [GIA, a long instrument with a thickness of 1cm, with a clamp at the end about the length of the index and middle fingers, and a dense stapler inside] please.”

“Yes, Doctor.”

Tae-kyung, receiving the heavy GI, stared intently at the monitor connected to the camera, and then stopped moving.

“No, let’s go safely. Grasper and Bovie [the end of the laparoscopic Bovie is shaped like a hook or spatula], please.”

Tae-kyung, receiving the instruments, gradually dug into the fat layers between the appendix and the colon.

Each time he cauterized with the laparoscopic Bovie, smoke filled the camera. Each time, he vented the gas inside through the ventilation valve next to the trocar.

The hand that had been digging in little by little stopped.

“It’s here. Give me that dissector.”

“Doctor, is that the appendiceal artery [the artery that supplies blood to the appendix, which can cause spurting bleeding if damaged]?”

Choi Mona, who had been focusing on assisting, carefully asked a question.

“That’s right. Especially in cases like this, it’s much larger than usual. It seems that the inflammation has been severe for a long time, causing it to become so deformed. I can’t imagine how long it has been in pain.”

“That’s right. I really don’t understand how they can do such crazy things to this young child. They’re not even human.”

“Dr. Choi is right. That woman is a piece of trash who has given up on being human, worse than a beast.”

“The expression ‘trash’ is really fitting. It must have been so painful, and they couldn’t even say anything. It’s heartbreaking to think about. Hemolok [a medical clip used to clamp blood vessels], please. 5mm size, please.”

“It’s 5mm.”

Tae-kyung very carefully took the vascular ligation clip fixed to the end of the instrument to the throbbing blood vessel. And he tightly clamped both sides of the blood vessel sequentially with the clip.

“Give me the Bovie again, and prepare the GI too.”

From the beginning, Tae-kyung had been planning to clamp the blood vessel supplying the appendix and the end of the appendix and colon at once. However, to block the child’s bleeding as efficiently as possible, he first clamped the blood vessel with Hemolok.

After that, he held the end of the colon again with the grasper and pushed it between the GI clamps.

After pushing about 2cm of the end of the colon into the instrument, he closed the end of the GI clamp tightly and pressed the button on the handle of the instrument.

“Click.”

The sound of the stapler being loaded into the GI instrument was heard.

Tae-kyung now carefully pushed the stapler button on the instrument handle forward little by little. His focused gaze glared menacingly at the monitor.

He pulled the button that had gone all the way back and released the clamp that had been holding the colon. Then, the area that had been clamped with the instrument was cleanly cut, and at the same time, small staples were densely embedded in the cut surface. Tae-kyung checked the condition and quickly removed the instrument.

“Okay! Give me the bag for the appendix to go out. The inflammation inside is severe, so I’ll put it in quickly.”

“Yes, Doctor”

The skilled hand rolled up the bag and inserted it through the large hole where the camera was inserted. And he put the cut part of the colon and the appendix into it with the grasper.

Then, the fifth vital sign, the third-stage fecal odor that filled the operating room, changed to a strong ammonia smell, like flipping a pancake.

‘It’s because of the inflammation.’

It was then that he thought the cause of the strong ammonia smell was inflammation.

“……!”

Along with the fifth vital sign smell, the range of that candy-like smell from Se-young greatly increased and rushed into his nose.

‘It’s definitely not the fifth vital sign.’

Until now, the fifth vital sign had been giving off a stronger smell, but the situation had changed from that moment.

The smell was the same as when he first smelled it. It was warm, and it had a clean, untainted, clear feeling.

It was like a joke, but it seemed to make his heart feel at ease, so much so that he felt sorry for being the only one smelling it.

‘Let’s focus on the surgery for now.’

Tae-kyung regained his composure and decided to postpone this issue for later. Above all, surgery was the priority now.

“Now, give me the needle.”

Until now, the instruments had handles at the end like guns, but the laparoscopic needle holder had handles like swords.

Tae-kyung slightly stretched his arm to the side of the child and inserted the instrument into the abdomen.

“Staplers aren’t a panacea. You have to suture one spot like this to prevent problems. Do you know what I mean?”

“Yes, Doctor.”

Then, Tae-kyung looked at the monitor and pricked the end of the colon with a needle. It was not easy to handle a small needle with the end of an instrument that was about 50-60cm long.

Even one suture required a large swing of the arm and delicate instrument manipulation, and he always had to be careful not to prick the surrounding organs.

Even doctors who have handled laparoscopy a lot find it difficult, and it takes several minutes each time they do it stitch by stitch. But Tae-kyung’s speed was a little faster than others.

‘Consistent and fast.’

Choi Mona was engraving Tae-kyung’s skills one by one in her eyes and remembering them in her head.

‘How much practice would he have to do to be able to handle the difficult laparoscopic needle like that?’

While Choi Mona was admiring, Tae-kyung sutured the end of the colon and cut the thread connected to the needle. And then, as he was about to pull out the instrument while holding the needle.

“Oh!”

The camera that Choi Mona was holding shook slightly and bumped into the instrument that Tae-kyung was pulling out, and the needle fell.

“……!”

Underneath where the needle fell were all important organs.

Even if the needle pricked the small intestine, it would have to be sutured again, and if, very rarely, a large blood vessel was pricked, he would have to open the abdomen without delay.

“Below! Look below!”

Tae-kyung instructed urgently but calmly.

“Choi Mona, camera.”

“Yes, Doctor.”

At Tae-kyung’s order, the camera, which had been showing the small intestine and its surroundings, frantically searched for the needle.

“It’s here.”

Fortunately, they were able to find the needle quickly. The needle was lying very quietly on top of the wriggling small intestines.

“Hoo!”

Tae-kyung let out a small sigh and quickly took out the needle with the instrument.

“I’m sorry, Doctor.”

“Yes, this one was worth apologizing for. Because there can always be variables in surgery, you must not let go of the tension for even a single second.”

“Yes, I will keep that in mind.”

It must have been a mistake that happened without her knowing because she was putting too much effort into wanting to do better. Fortunately, there were no problems, but Tae-kyung did not forget to pay attention.

“Okay! I’ll take out the trocar.”

Tae-kyung took out the bag containing part of the colon and the appendix through the large navel hole where the trocar was fixed. And after carefully suturing the three small holes, the surgery ended with the drain as the last step.

“I’ll put a drain [a small bag that sucks up fluid caused by inflammation or bleeding] inside the abdomen. Everyone worked hard.”

“You worked hard.”

“You worked hard, Doctor.”

“The person who worked the hardest today is Se-young. Our Se-young worked hard.”

Tae-kyung showed a warm smile as he looked at Se-young lying on the bed.

“That’s right. As you said, Doctor, the person who worked the hardest today is Se-young. She’s very admirable.”

“And please tell the ward.”

Tae-kyung said, tearing off his sweat-soaked surgical gown.

“The child’s inflammation is so severe that I’ll keep her fasting and use the maximum dose of antibiotics, finding the pediatric dosage.”

“Yes, Doctor.”

“I’ll use Tazobactam-piperacillin [a more powerful antibiotic than the 3rd generation Cepha above], and I’ll check the lab every day. Use pediatric fluids and give her a private room, no, a VVIP room, regardless of the cost.”

Tae-kyung assigned Se-young to the only VVIP room in our hospital.

“Tell them to talk to me about the cost issue, and it’s obvious, but don’t tell anyone the child’s room, except for the police, and tell them to keep it a secret so that she doesn’t go outside.”

“Yes, I will deliver it right away.”

“We just removed the small but very dangerous leftovers that the child brought out of hell. There is still pain and hell left in this child’s heart. We can’t completely eliminate it, but let’s be the beginning of that. Everyone, please pay special attention to Se-young.”

The surgery went well, but Tae-kyung knew that it was another beginning.

There were legal issues and inflammations that needed to be resolved for the child’s health.

“Let’s solve them one by one.”

Tae-kyung thought that the remaining problems would be solved well, just like today’s surgery, and left the operating room.