Fifth Vital [EN]: Chapter 168

Fifth Vital Sign – Episode 168 (168/502)

Episode 168. The Entire 40 Minutes

Blood was trickling through the mesentery [a membrane that attaches the intestines to the abdominal wall] connected to the small intestine.

“That’s it. It’s here.”

The moment Tae-kyung grabbed a section of the small intestine and lifted it,

“Huh!?”

Tae-kyung’s eyes widened, and he saw it.

When the blood-flowing part of the small intestine is lifted, the mesentery connected to it, like a curtain, naturally rises.

Blood vessels are connected there, and it mainly functions to hold the small intestine in place, so it only rises about 10cm. But the tumor was clearly visible at that moment.

A tumor of a very hideous shape was visible.

“Dr. Tae-kyung, here, in the small…”

Lee Chan-hee, who was assisting, started to speak but quickly stopped himself.

‘If I say it now, it feels like I’ll break his concentration for no reason. Better to keep quiet.’

He couldn’t bring himself to continue speaking because of the intensely focused look in Tae-kyung’s eyes.

A tumor was bulging on the wall of the small intestine, and blood was gushing from it. Tae-kyung was taken aback by its location, shape, and condition.

The location in the small intestine was not ideal, and the shape of the mass now visible was irregular. Moreover, the tumor was bursting with blood.

If a tumor is malignant, blood vessels develop rapidly because its growth rate is faster than other cells.

If this is malignant—and it looks likely—cancer cells have probably already spread throughout the abdomen.

It would be safe to assume that cancer cells were released into the abdomen as the blood vessels burst. Even with the naked eye, cancer cells appeared to be present in the abdominal cavity.

The exact pathology results would have to confirm, but it was clear that the situation was not good.

“Right angle, please.”

Tae-kyung used the right angle clamp to block off the arteries around the bleeding area one by one.

Click-

“Give me another one.”

“Yes, Doctor.”

“Just one more, and a tie.”

Tae-kyung held up the black thread passed to him on the end of a mosquito forceps [a small forceps with a slightly curved tip]. Then, Lee Chan-hee held the right angle that Tae-kyung was holding in the same position.

Tae-kyung manipulated the mosquito forceps to rotate around the right angle, allowing the thread to wrap around the blood vessel at the end.

He adjusted the length of the thread crossed over the blood vessel, released the mosquito forceps, and quickly tied it off.

“Going further.”

With nimble hand movements, four ties were quickly made.

“I’ll do one more.”

After repeating the procedure once more, he released the right angle.

“Metzenbaum scissors, please.”

Tae-kyung cut the ligated artery and the remaining thread after the knot to avoid damaging the tissue.

After ligating all the supplied arteries, he prepared to cut the small intestine along with the tumor by cutting the mesentery around the small intestine piece by piece.

He separated about 20cm of the small intestine from the mesentery, centering on the mass of unknown malignancy, and made holes with an electrocautery device about 10cm away from the tumor.

“GI, please.”

As the nurse handed over the device, Tae-kyung pushed the thumb-thick instrument into the hole in the small intestine. Then, he pushed the matching instrument into the hole in the other part of the small intestine that was in contact.

After that, he brought the two instruments together, applying force to ensure the boundary was completely sealed.

“One, two, three, four… ten. Dr. Lee?”

“Yes.”

“Were you about to ask what I’m doing?”

Tae-kyung asked, and Lee Chan-hee, who was just about to ask, nodded vigorously.

“How did you know?”

“It was written all over your face. The reason for doing this is that if you cut the small intestine right away, it can swell and the boundary might not be good, so we compress it with a machine to reduce swelling before cutting.”

“Ah, I see.”

“Watch carefully, put it in your head, and don’t forget it.”

“Yes, Doctor.”

Tae-kyung, judging that he had applied enough force to the part where the machines were pushed into each small intestine and brought into contact, activated the device and moved the button from end to end with a ‘click’ sound.

Click-clack- Click-

With the sound of the machine, the two small intestine walls inside the machine’s contact surface were incised, forming one passage.

Holes were created between the small intestines, which were originally 20cm apart. And the area around the passage was automatically sutured by the stapler.

“Good.”

Tae-kyung carefully looked inside, checking for bleeding.

“Again, please.”

Now, he crossed the machines under the connected passage to remove a portion of the small intestine and the tumor together.

Click-clack-

Tae-kyung, who had operated the machine again, transferred the cut-out pieces to a metal bowl.

“Please send this for biopsy. The specimen is the small intestine.”

“Yes, I understand.”

“I’ll do irrigation.”

As Lee Chan-hee spoke, Tae-kyung stared blankly and shook his head.

“No. Let’s just not do it.”

“Are you saying we shouldn’t do irrigation now?”

“Yes.”

“Why?”

Lee Chan-hee couldn’t understand why he suddenly didn’t want to do irrigation [flushing the abdominal cavity with fluid].

“Cancer cells would have already spread inside due to the blood, and if we pour water here, it’s like spreading the already spread cancer all over the abdominal cavity. I don’t know if it’s malignant yet, but judging from the shape, it’s likely to be.”

“Ah… Yes, I understand.”

“Let’s just suction and dab with dry gauze to secure the field of vision without rubbing.”

“Yes, Doctor.”

Tae-kyung now checked each and every organ, lifting them up to see if there were any more sources of bleeding.

He meticulously checked for bleeding from the small intestine to the end, as well as the large intestine, liver, and all intra-abdominal organs.

‘He’s looking incredibly thoroughly today.’

‘He’s really checking every nook and cranny.’

‘That’s just like him.’

Lee Chan-hee, Euijin, and the medical staff all thought to themselves.

Tae-kyung, who was known for being meticulous in the operating room, was even more so today.

Everyone fully understood his feelings since the patient lying on the bed was a close colleague.

He looked so meticulously that this process alone took 40 minutes.

“There’s none… there’s none. There’s nothing.”

He said the same words several times, as if telling himself to move on because there was nothing more.

The head that had been bent over for 40 minutes was finally raised.

“Alright! Let’s close. Detach, please.”

As Lee Chan-hee used instruments to secure the field of vision to show the fascia [a layer of connective tissue], Tae-kyung sutured the fascia together one by one. And the subcutaneous tissue and skin were quickly sutured.

“Thank you for your hard work.”

“Thank you for your hard work, Doctor.”

As the surgery completion greetings were heard, Tae-kyung briefly looked at Lee Dong-hoon’s face.

The formalin smell vibrating at the tip of his nose disappeared along with the removed tumor.

However, the smell was not completely gone. The level had decreased, but Lee Dong-hoon’s fifth vital sign still lingered.

“Everyone worked hard today. Lee Chan-hee?”

“Yes, Doctor.”

“Wake the patient up, and call me when he’s in the recovery room.”

“Yes, I understand.”

Tae-kyung took off his surgical gown and left the operating room.

The surgery was definitely clean and well done. But he felt uneasy because of the shape of the tumor.

He was worried about how Lee Dong-hoon, the person involved, would react and struggled with how to convey the information.

“Ha!”

Tae-kyung returned to his office and sat heavily in his chair, letting out a long breath.

Knock knock-

While he was thinking about Lee Dong-hoon, he heard a knock.

“Are you in there?”

It was Euijin’s voice.

“Come in.”

Click-

“I knew you’d be here. Here you go!”

Euijin handed Tae-kyung the mug she was holding.

“Have a cup of warm lemon tea.”

“It smells good. But why lemon tea all of a sudden?”

“Just because. I thought it would help you recover from fatigue, Doctor. Lemon tea is good for fatigue recovery.”

“Okay. I’ll enjoy it.”

“Is it because of Lee Dong-hoon?”

Euijin noticed that Tae-kyung’s expression was different from usual, even though the surgery went well.

“I can’t deny it. I was thinking about how to tell him, wondering if he might be emotionally distressed.”

“I only saw him briefly, but I got the feeling that he’s a very bright person.”

“He really is a bright person. That’s why I’m even more worried.”

The reason Tae-kyung was so worried was not only because a close friend had undergone surgery.

It was because the person was Lee Dong-hoon.

There was one modifier before Lee Dong-hoon’s name: ‘Limitless Positivity Man.’

It was a nickname given to him by people because of his always smiling and positive personality. But now, Tae-kyung was worried because of that personality.

Of course, there are cases where positive people overcome illnesses well. However, when meeting and treating patients in the hospital, there are more cases of the opposite than one might think.

People who are usually very cheerful and positive tend to collapse when told about a serious illness.

‘I lived positively, so why did this illness come to me?’

They struggle emotionally with the question of ‘Why me of all people?’ This can affect treatment, so managing the patient’s mental state is also important.

Lee Dong-hoon was bright until the moment he entered the operating room. Tae-kyung was worried that he might be greatly disheartened.

“I had a similar experience before.”

“Huh?”

“When I was an intern, my closest colleague was sick and had surgery. He was with me until the professor came and asked me questions. So, I tried to speak as positively as possible, but I got scolded a lot by the professor later.”

“You deserved it.”

“I know. I didn’t know much because I was an intern.”

Tae-kyung could immediately understand the professor’s feelings.

When talking to patients about their illness, you have to convey the facts as they are, without adding or subtracting anything.

Deliberately emphasizing only positive stories for the sake of the patient is not a good method.

In fact, Tae-kyung knew this best and had been doing it all along.

It is important to be honest, regardless of the individual patient’s personality.

“Aren’t you just worrying too much because he’s a close friend?”

Euijin was right.

He was worrying more than usual for Lee Dong-hoon’s sake. Worrying only increases the train of thought and doesn’t help at all.

“Just do it as usual. There are few doctors as good as you at building rapport.”

“Me?”

“Do you know that it’s not good when a talented person is too humble?”

“Really? Then it must be a bit not good.”

“No, it’s not.”

“Thanks, Euijin.”

“You’re welcome.”

Rrrrrrrrrr

“Oh. He’s awake? I’ll go now.”

Click-

Tae-kyung, who received a call from Lee Chan-hee, got up from his seat.

“Are you going to see the patient?”

“I have to.”

“Oh, by the way, what happened to that friend from before?”

“She had cancer, but she was completely cured and is now working as an obstetrician, delivering babies well.”

“That’s a relief.”

Whatever reaction Lee Dong-hoon showed, Tae-kyung’s attitude was the same.

As always, he just needed to treat the patient well until the end and guide him well in that direction so that good results could come out.