Fifth Vital [EN]: Chapter 2

Fifth Vitality – Episode 2 (2/502)

Episode 2. The Conductor of the Operating Room

“What’s this patient’s TMN stage?”

While putting the towel used to wipe his hands into the sterile container, Tae-kyung asked the resident.

“Yes, Doctor. According to the CT scan, it’s T2N0M0 and located in the left colon. The enhanced CT scan is on the screen.”

Tae-kyung put on the surgical gown handed to him by the nurse and shifted his gaze to the screen.

“Professor Lee was supposed to handle this, so I didn’t follow up. Were there any events?”

“No, there weren’t.”

“Was this taken in the emergency room?”

“Yes, Doctor.”

“What about this patient?”

This question wasn’t just about the patient’s condition. Usually, he would examine and interact with the patient before surgery, but he was filling in as a substitute at the last minute and didn’t know much about the patient. All he knew was that the person had a remarkably bright face and greeted him very well.

“Since Professor Lee was continuously seeing this patient, we don’t know much either.”

Well, it wasn’t crucial to know what kind of patient this was right now. The important thing was to complete the surgery successfully.

“Please take good care of me today as well.”

Tae-kyung nodded to the anesthesiologist next to the patient, who was under general anesthesia, and greeted him.

“Of course. Don’t worry. By the way, I heard you suddenly took over Professor Lee’s patient because a VIP emergency came up today?”

The anesthesiologist asked Tae-kyung while looking at the monitor.

“Yes, that’s what happened.”

“So that’s why everyone rushed over there earlier.”

The VIP who suddenly came in as an emergency was the chairman’s wife. She had as much influence as the chairman, so doctors who didn’t want to be on her bad side rushed to make their presence known.

For Tae-kyung, who had to wrap things up at the hospital within a few days, it was a distant story that no longer concerned him.

“Still, the fact that the picky Professor Lee always entrusts you with emergency surgeries shows how much he values you.”

Anesthesiologist Lee Dong-hoon, who usually liked and supported Tae-kyung, was a good person who was always easygoing, but he had one flaw: he lacked tact. As a result, he was always a step behind on news within the hospital.

“Becoming a medical professor isn’t something just anyone can do. Especially for people like us who have no money or connections, getting a professor position is like reaching for the stars.”

“Doctor, are you watching the monitor carefully?”

The head nurse in the operating room gave him a look, but Lee Dong-hoon continued to speak.

“I’m watching it carefully. Where was I? Right! Doctor Kim is skilled, so you should unconditionally bow down to Professor Lee.”

“Dr. Dong-hoon, I think it would be better if you stopped. I’m sure Dr. Kim will do well on his own.”

“What are you talking about? How long have I endured? Anyway…….”

“Ugh! Please stop it already.”

Eventually, the head nurse couldn’t stand it any longer and raised her voice.

“Dr. Kim didn’t get the professor appointment.”

“Ah……!”

At the head nurse’s words, Lee Dong-hoon was embarrassed, and the atmosphere in the operating room instantly turned somber.

“Sorry, Dr. Kim. I was just being nosy.”

“I’m sorry too. I shouldn’t have said anything.”

“Why are you both apologizing? I’m fine, so don’t worry about it.”

It was a lie. He wasn’t fine at all.

But he decided to forget about not getting the professor position and being fired from the hospital, at least for this moment.

“Now, let’s all focus on the surgery.”

More than anything, it was time to focus on the surgery of the patient who had entrusted their life to him.

“Play the music.”

Paganini’s Caprice 24 flowed into the chilly operating room. The music was like a signal for Tae-kyung to start the surgery.

As the music played, the anesthesiologist, the third-year resident, the intern, and the two nurses began to focus on the patient in their respective positions.

And in an instant, concentration filled Tae-kyung’s eyes.

“Then let’s begin the surgery.”

He makes an incision in the skin with a bovie [electrocautery device] as if holding a pencil in his right hand.

Because he is an elderly patient, he has a lot of fat in his peritoneum [abdominal lining] even though other parts of his body are dry.

The first assistant next to him holds and pulls the flesh so that he can cut well.

As Tae-kyung cauterizes and opens the flesh with the bovie, the smell of burning flesh begins to fill the operating room.

At the same time, the assistant brings a suction device to the incision area to suck up the smoke.

After cutting through the skin, the muscle layer appeared. After retracting all the thick muscle layers, he installs the equipment so that the surgical site is clearly visible.

In the operating room, there is no need to ask for tools. As the nurse hands Tae-kyung the installation equipment, he installs it with the assistant.

“There is no perforation.”

Unlike the resident and intern, who cannot speak carelessly in the operating room, the head nurse, who has many years of experience, breaks the silence.

“I thought there would be peritonitis [inflammation of the peritoneum] and the inside would be a mess because there were symptoms of sepsis [blood poisoning], but thankfully, it’s not.”

With the field of vision secured by the equipment, he must now feel around for the cancerous mass with his hands. But before that, there was something he had to do first.

“Let’s remove the gas first.”

Tae-kyung plans to remove the gas before looking for the cancer. This is because the patient’s large intestine is blocked by the cancer, and his abdomen is full of stool.

Removing the gas is more important than you think. If the pressure of the gas compresses the large intestine, it can block blood flow or cause perforations elsewhere.

Tae-kyung carefully touched the large intestine. Then, he grabbed a spot far from the cancer and pierced it deftly with a needle.

“……!”

The moment the sharp needle pierced the large intestine, an enormous stench filled the operating room.

‘It’s terrible…….’

Tae-kyung’s brow furrowed slightly. It was always the same, the stench was unbearable. It was a smell that was hard to get used to, no matter how many times he smelled it.

The moment everyone in the operating room grimaced,

“Ugh! Ugh!”

The intern, who was like air in the operating room, gagged involuntarily at the stench he was experiencing for the first time.

“I’m sorry. I’m sorry, Doctor.”

The intern, seeing the resident’s sharp gaze, conveyed his apologies to Tae-kyung.

“It’s okay. It can happen when it’s your first time.”

An intern is probably more nervous than a new recruit in the army. Tae-kyung recalled his own time as an intern and offered words of encouragement rather than scolding.

Everyone in the operating room must be suffering, but the person suffering the most right now was Tae-kyung, who was closest to the patient.

Facing the continuous stench, Tae-kyung thought.

‘I think I’ll have to take it out together.’

It is impossible to incise this patient and remove only the lesion separately. So, he decided to take out the cancer and the stool all at once to the side.

Of course, since sterilization may be compromised during this process, it must be done after creating an ostomy [surgically created opening in the abdomen for waste removal] and removing it to the left.

Tae-kyung cut away the surrounding structures, such as fat, blood vessels, and nerves, one by one to resect the large intestine.

Among the severed blood vessels, there were blood vessels that had to be reconnected, and the ends of blood vessels and nerves that did not have to be reconnected had to be carefully sutured. And that decision is solely up to the doctor performing the surgery.

This process requires a great deal of concentration, and this is where the difference in skill between doctors is revealed.

‘I’m getting nervous.’

The intern, who was using suction to secure the field of vision, swallowed hard and said to himself.

Tae-kyung’s pupils rapidly dilated and contracted, and his hand holding the needle began to move frantically. It looked like he was moving randomly, but that was not the case at all.

Like a conductor leading an orchestra, Tae-kyung was conducting the patient’s life with the tip of his finger.

The small needle moved smoothly and effortlessly between the narrow blood vessels and nerves.

‘Wow! How much practice must he have had…….’

It was then that the intern, who was experiencing Tae-kyung’s hand movements for the first time, was exclaiming in admiration to himself.

“Hey, you son of a bitch!”

Suddenly, a thunderous curse erupted in the operating room, which had been filled with tension.

“What are you doing!?”

It was the voice of Tae-kyung, who had been extremely careful not to touch the nerves incorrectly. He, who was known for being a nice person, did not curse in the operating room. But the current situation was an exception.

“What are you doing right now!?”

It was because the intern, who was the third assistant and was too focused on Tae-kyung’s movements, had pulled the retractor [surgical instrument used to hold back tissues or organs] that was pulling the small intestine too hard. Pulling the device too hard could sever the nerves of the small intestine.

“Do you want to cause a patient’s table death!?”

“I’m sorry, Doctor.”

“You came into the operating room to save the patient.”

That was a hundred or a thousand times true.

Because a person’s life is in the hands of the doctors, they must always be on their toes.

Therefore, it was only natural for interns to be scolded like Tae-kyung was doing now when they made mistakes.

“I will keep that in mind.”

The intern was on high alert at Tae-kyung’s charismatic appearance.

“Get your act together! Got it!?”

“I’m sorry. I’ll get my act together.”

After the stern scolding, the intern refocused and held the retractor, and the surgery continued.

Tae-kyung made an incision in the rectum as close to the center of the body as possible and then wrapped it in gauze. He wrapped it in several layers of gauze to prevent the bacteria from the stool from coming out, in case sterilization was compromised.

“Hold this.”

“Yes, Doctor.”

After telling the intern to hold the rectum, Tae-kyung makes an incision of about 2 cm for the colostomy [surgical procedure that brings one end of the large intestine out through the abdominal wall]. Then, he makes an incision on the patient’s left side, pulls out the intestine, and sutures the abdominal wall.

With the extracted large intestine facing completely downward, he carefully incises the cancerous mass and the stool mass at the same time, being careful not to compromise sterilization.

Then, he gently presses down on the abdomen to ensure that the decompression in the large intestine is complete.

“That’s a really nasty smell.”

The anesthesiologist, who had been focusing on the monitor, couldn’t stand it any longer and spoke, as an even worse stench than before vibrated.

“It’s all done, Doctor.”

Tae-kyung, who threw a word at the anesthesiologist who was frowning severely, suctioned the remaining stool and then completely sutured the ostomy, ending the surgery.

“Thank you for your hard work.”

Tae-kyung came out of the operating room, receiving greetings from the assistants.

The fact that he had saved another patient today warmed his heart. He felt even better on days like today when the surgery went well according to his wishes.

No matter how difficult and exhausting it was, he still thought that being a doctor was his calling.

‘Being comforted by surgery.’

It was a joke, but thanks to the successful surgery, his heavy heart felt a little better.

“Anyway, they say surgery is a game of skill, and Dr. Kim’s technique is something to be admired.”

Lee Dong-hoon, the anesthesiologist who came out of the operating room, gave a thumbs up and praised Tae-kyung while washing his hands.

“And I’m sorry about earlier. I’m a bit slow, as you know.”

Lee Dong-hoon apologized, as if he was bothered by his remarks in the operating room.

“Anyway. You have to take care of that mouth of yours. Anyway, I’m really sorry.”

“Why are you apologizing again? I’m really fine.”

“Well, there will be another chance next time. Let’s close our eyes and wait one more time.”

“I don’t think that’s going to happen.”

“Why?”

Lee Dong-hoon couldn’t even think of the obvious follow-up question, ‘Are you going to move hospitals?’ This was because, unlike other people, Tae-kyung had lived like a resident ghost of Shinhwa University Hospital [someone who has been at the hospital for a very long time].

“I got fired.”

“Huh!”

How could he say he was fired with such a smile? Lee Dong-hoon froze as if he had stepped on a landmine.

“Am I having a bad day today? I keep making mistakes. Dr. Kim, I don’t know how to comfort you.”

“Buy me a drink of consolation next time.”

“Sure. What do you mean by one drink? I’ll treat you to a big one. Dr. Kim, you’re skilled, so you’ll do well in the future.”

“Yes, thank you.”

Lee Dong-hoon, who was embarrassed, quickly changed the subject to change the atmosphere.

“By the way, Dr. Kim, you don’t usually get nervous during surgery, do you?”

“What are you talking about? I do too!”

Tae-kyung, who was washing his hands with a bright expression, shook his head lightly as he felt a slight dizziness.

“…….”