Fifth Vital [EN]: Chapter 160

Fifth Vital Sign – Episode 160 (160/502)

160. A Sea of Blood

“Are the surgical tools and video ready?”

“Yes, Doctor. They are ready.”

Even the cold air, typical of an operating room, felt tense today.

“Let’s begin the surgery.”

Tae-kyung received the scalpel and placed it on the patient’s abdomen, making a long incision from top to bottom.

Normally, Tae-kyung would cauterize as he went, but now, opening the abdomen was the priority.

He needed to quickly open the abdomen, examine the inside, and identify the source of the bleeding.

As soon as the sharp scalpel opened the abdomen, blood rapidly flowed onto the surgical field, instantly creating a sea of blood.

The flowing blood stained the medical staff’s feet and dripped onto the floor.

“Give me a vasopressor [medication that raises blood pressure] and a vasoconstrictor [medication that narrows blood vessels].”

“Yes, understood.”

“We’re administering blood and fluids via bolus [a single, large dose], and the blood pressure is 80.”

The fifth vital sign [level of consciousness], seemed to mock Tae-kyung, its presence growing stronger, and his brow furrowed deeper with each worsening sign.

‘Damn it! There’s too much!’

Time was short, and the bleeding was profuse. The amount of blood loss was so severe that his vision was obscured.

It felt like driving through a pitch-black tunnel without any headlights.

“Suction, hurry! Let’s secure the field of vision.”

“Yes, Doctor.”

Shuuk-

After a while of suctioning, the source of the bleeding finally became visible. Blood was continuously flowing from the back of the stomach.

‘Please, not the pancreas.’

Tae-kyung hoped it wasn’t the pancreas. If there were problems with the pancreas, it would be difficult to stop the bleeding, and many more procedures would be necessary afterward.

“Suction!”

Tae-kyung, who was thinking with his head and moving his hands instinctively, suddenly raised his voice.

“Do it properly!”

“I’m sorry, Doctor.”

“You can’t see here.”

“I will do it properly.”

Lee Chan-hee flinched at Tae-kyung’s shout and gripped the suction device again.

It wasn’t that Lee Chan-hee was distracted or not focused. If concern for the patient were a measure, he would probably be the most worried person in the operating room.

Rather, he was too worried, which was the problem.

Seeing Park Joo-dang’s abdomen filled with blood, he felt guilty, as if it were his fault, and this led to mistakes in his movements.

‘Focus! The doctor is operating, so it will be okay.’

Tae-kyung was not one to easily accept a patient’s death on the table.

Lee Chan-hee always had one thought: the moment he arrived at the hospital, the person he trusted more than himself was Tae-kyung. So, he just needed to trust Tae-kyung in this surgery as always.

Lee Chan-hee cleared his mind of guilt and other distracting thoughts and focused solely on assisting.

After that, the suction continued to move busily. Finally, the posterior abdominal wall became visible, and the cause could be identified.

“Lee Chan-hee? Can you see here? Where is the bleeding coming from?”

“The spleen, Doctor.”

“Correct.”

Indeed, the spleen was the source of the continuous bleeding.

When he went to Park Joo-dang after hearing the code blue [emergency situation], Nurse Lim Jung-sook had mentioned that the patient strongly complained of left upper quadrant pain during the initial palpation [physical examination by touch].

The spleen was damaged, as indicated by Park Joo-dang’s left upper quadrant pain.

“Damn it! The spleen is too damaged.”

That was the truth.

It was fortunate that it wasn’t the pancreas, but instead, the spleen was severely damaged, almost as if it had been crushed, and blood was flowing out.

“Doctor, the spleen damage seems too severe.”

Lee Chan-hee said cautiously.

“I see. It’s going to be hard to save. Kelly clamp, please.”

Judging that he couldn’t stop the bleeding from the damaged area of the spleen, Tae-kyung clamped the entire artery leading to the spleen, blocking it off.

It was the splenic artery, which branched directly from the abdominal aorta to the spleen.

Drrr-

“One more, please.”

Soon after, he clamped both sides of the artery and vein with instruments.

“Suture tie, please.”

Tae-kyung tied the clamped blood vessels with thread, making a knot.

He applied force precisely to the knot, pushing it onto the blood vessel for the desired ligation [binding]. Then, he pulled the thread with all his might. He repeated this process, tying both the artery and vein, and then cut between the Kelly clamps.

“Adjust the lighting. And show me if there’s any bleeding at the cut site.”

“Doctor, fortunately, the bleeding seems to be stopped.”

“It’s too early to be sure.”

The stage 4 odor [likely referring to the smell of blood and tissue damage] that had been permeating the entire operating room was gradually subsiding, but Tae-kyung didn’t agree with Lee Chan-hee’s words. A thorough confirmation was necessary.

“We need to examine it more carefully in situations like this.”

With the lights shining on the abdomen, Tae-kyung moved the small intestine around, checking for any other bleeding sites. Then, he carefully examined the pancreas, duodenum, liver, and other organs for any other bleeding.

“Hoo!”

After thoroughly examining the organs for about five minutes and confirming that there were no other sources of bleeding, Tae-kyung finally let out a sigh of relief.

“Still, it’s a stroke of luck. How’s the patient’s blood pressure?”

“It’s rapidly stabilizing, showing a systolic pressure above 90, and the HR (heart rate) has decreased to the 110s.”

The strong formalin odor [disinfectant] that had been fading was also quickly decreasing in intensity.

“Bovie [electrocautery device] and lift the spleen here, please.”

“Yes, Doctor.”

With the source of the bleeding definitively secured, Tae-kyung quickly began to clear the structures around the spleen.

He cut the ligaments connected to the stomach and the structures attached to the back of the abdominal wall one by one with the electrocautery to remove it.

“Receive the spleen, please.”

“We’ll send it for a biopsy with a frozen section [rapid tissue analysis].”

“Now, I’ll irrigate the abdomen. Saline, please.”

“How much will you need?”

“Prepare 10L for now.”

The operating room nurse poured saline into a metal container. She finished pouring one container and was about to pour another when Tae-kyung suddenly stopped her.

“Wait! Give me that one first.”

Tae-kyung quickly stopped the nurse’s action and checked the temperature of the saline in the container.

“Yes, Doctor. Here it is.”

“This won’t do. It’s too cold. Give me a warm one. The patient has already lost a lot of blood, and this will cause hypothermia [dangerous drop in body temperature]. Mix it quickly.”

Before he finished speaking, the nurse mixed warm saline with regular saline to create water of a suitable temperature. She then drew the saline from the container with a pipette and handed it to Tae-kyung.

“Not that. Just give me the whole container of saline.”

“The container? Ah! Yes, understood.”

Tae-kyung slowly poured the saline-filled container into the patient’s abdomen, gently washing the small intestine and other organs with the water. The small intestine floated in the saline-filled abdomen, and then he suctioned the saline again.

“A little more.”

“More, please.”

“I’ll do it one more time for the last time.”

After pouring it about three times in total, Tae-kyung finally seemed satisfied and began to close the abdomen.

The intense battle in the operating room was finally over.

“Once the patient’s abdominal wall is closed, transfer them to the ICU [Intensive Care Unit] immediately. And once they’re stable, we’ll do a chest and abdominal CT scan [Computed Tomography scan].”

“Yes, Doctor.”

“Give the patient an O2 mask at 5L and take them to the ICU right away.”

As soon as the resident finished speaking, a wide bed for transferring Park Joo-dang to the ICU entered the operating room.

“Thank you for your hard work.”

“Everyone did a great job.”

“Has the patient’s guardian arrived?”

“Yes, Doctor. They said they’re in the waiting room.”

Tae-kyung took off his sweat-soaked surgical gown and left the operating room to see the guardian.

* * *

“Honey?”

Park Sun-young, who was holding her hands tightly in the guardian waiting room, was handed a bottle of water from the vending machine by her father-in-law.

“I thought you might be thirsty, so I bought one.”

“Thank you, Father.”

Park Sun-young looked up with red, bloodshot eyes and a worried expression.

“Don’t worry too much. Your father is strong and resilient. Nothing will happen. The surgery is over, so the doctor will be here soon.”

“Yes.”

Park Sun-young had also seen the message on the waiting room monitor that the surgery was over, but her heart was still racing. She felt that she would only be able to calm down after hearing from the doctor.

“Park Joo-dang’s guardian?”

“Here. Honey, the doctor is here.”

Park Sun-young, who had been praying with her eyes closed, quickly got up and walked towards Tae-kyung.

“I’m his daughter. Is my father okay?”

“Yes. The spleen was damaged, causing bleeding, but fortunately, the bleeding was well controlled, and the surgery went well.”

“Oh, thank goodness.”

“Because of his age, he’ll have to be monitored in the ICU, but I believe he will recover. Please don’t worry too much.”

“Ah! Thank you, Doctor.”

“Thank you. Thank you for your hard work.”

Park Sun-young and her father-in-law expressed their gratitude without hesitation.

“Is it possible to see my father for a moment?”

“Yes, the nurse here will guide you. I’ll see you again later.”

“Thank you so much, Doctor.”

“I’ll guide you.”

After Tae-kyung left the guardian waiting room, Park Sun-young followed Nurse Lim Jung-sook to the ICU.

“In the ICU, only one guardian can visit at a designated time once a day. You’re seeing him briefly now after the surgery. Which one of you will go in?”

“Me. I’m his daughter. Father, I’ll go in and come back.”

“Okay, go ahead.”

“Please follow me this way.”

Park Sun-young was guided to see her father, who had just been moved to the ICU.

“The patient will need some more time to wake up, and as you heard earlier, the surgery went well. I’ll give you some privacy.”

“Yes, thank you.”

Park Sun-young reached out her trembling fingertips towards her father’s hand, but she couldn’t hold it.

Park Joo-dang’s hands were covered with needles, IV lines, and various medical devices.

“Hic! Why does my dad look so old?”

Park Sun-young, looking at her father’s face, which seemed as if he were sleeping peacefully, sobbed and whispered softly.

Her father, whom she hadn’t visited for a while because she was busy with life, seemed even older.

“I should have paid more attention… I’m sorry.”

It all felt like it was her fault. She knew that her father was drinking more often because he was lonely, but she felt guilty for doing nothing, using the excuse that she was busy with life.

“Thank you for being alive, Dad.”

It was another moment when the saying ‘Let’s do well while they’re still alive’ felt desperately real.

“I’ll come to the visitation tomorrow.”

Park Sun-young kept her eyes on Park Joo-dang’s face for a while and left the ICU with heavy steps.

“Nurse, please take good care of my father.”

“I’ve already spoken to the ICU doctor, so please don’t worry too much.”

“Thank you.”

“You’re welcome. I’ll see you again then.”

“Yes, thank you.”

“Honey?”

Park Sun-young, who had finished talking to Nurse Lim Jung-sook and was looking around, was called by her father-in-law.

“Father, where did you go?”

“I just went to the restroom for a moment. Did you see your father okay?”

“Yes, he hasn’t woken up yet, so I think I can come and see him during visitation tomorrow.”

“Then let’s go home and come early tomorrow.”

“No. Father, I looked it up, and there’s a sauna nearby, so I’ll sleep there. Father, please go home quickly.”

Park Sun-young didn’t think she could sleep comfortably leaving her father alone in the ICU.

“What are you talking about? If you don’t go, I won’t go either. How are you going to sleep in a sauna? I know you’re upset, but let’s go home first. Even if it’s just for an hour, rest comfortably at home and come back. You’ll end up getting sick. Okay? Sun-young, let’s go home.”

“…Yes, I will. I’m sorry for the trouble.”

“And take this.”

Her father-in-law handed her a crumpled, tied black plastic bag and walked away slowly.

“…?”

Park Sun-young, who was checking the inside of the bag with a rustling sound, was startled and quickly tied the bag, running towards her father-in-law, who was walking away.

“Father!”