Fifth Vital [EN]: Chapter 221

Fifth Vital Sign – Episode 221

Episode 221. Defibrillator! Get it here!

The CT results were in.

Tae-kyung sat at the station monitor, repeatedly reviewing the CT images, his arms crossed as if frustrated.

“Does patient Oh Jae-bal have a perforated bowel?”

Lee Chan-hee, who was watching the monitor with him, asked.

“No. The CT is normal.”

“Yes?”

“There’s no problem like a hole in the intestines or pus collecting anywhere.”

“Then what’s the matter…?”

“Then there’s only one reason.”

Tae-kyung got up from his chair and put on his doctor’s gown. Then, he walked to the patient, who was stable after the emergency treatment.

Lee Chan-hee, seeing this, hurriedly followed him.

“That’s… the troublemaker.”

“Yes…?”

Tae-kyung, talking to himself, unbuttoned the patient’s top and pointed to something bulging out on his chest with his fingertip.

“We need to remove this.”

The firm fingertip pointed to a chemo port (a device implanted under the skin of the chest for easy access during chemotherapy, with the end of the tube inserted into a large blood vessel).

“Ah! Could bacteria have grown there?”

“We’ll have to do a test to find out, but when the cause isn’t clear, it’s best to remove any foreign object inside the patient as soon as possible. If bacteria have grown here, it won’t get better no matter how many antibiotics we use. The bacteria will continue to be supplied by this structure.”

“Yes, then I’ll contact Professor Jung right away to open the operating room and prepare.”

“No!”

Tae-kyung said to Lee Chan-hee’s back as he turned to leave.

“We’ll do it here.”

“Yes? H-Here?”

“Yes. No time. Tell them to bring the sterile drapes and tools here. Quickly!”

“Yes, I understand.”

Soon after, two operating room nurses spread sterile drapes around Oh Jae-bal.

The patient had already taken off his top, and the area around the chemo port was disinfected with iodine solution.

Tae-kyung held the Bovie [electrocautery tool] and incised the patient’s upper right chest, where the chemo port was bulging. The port was about 1 cm long and had a round structure.

It’s a simple surgery that ends when you incise here and detach it from the surrounding structures. But no matter how simple it is, bleeding occurs when you incise the skin and dig down.

That’s why Lee Chan-hee wiped away the blood each time.

“Go under the port here and dissect the adhesions with the Bovie. You can try it later, Dr. Lee. It’s not that difficult.”

“Yes, Professor.”

After detaching all the entrances of the port and pulling out the tube inserted into the blood vessel, and then placing all the long tubes on the surgical table, that’s when it happened.

“Please give me something to suture.”

Ding-dong! Ding-dong! Ding-dong!

“Professor, the patient’s electrocardiogram is abnormal.”

With the alarm, Tae-kyung looked at the real-time electrocardiogram. The heart was fluttering with a much shallower waveform than usual.

“Professor, it looks like A-fib (Atrial fibrillation)!”

“The patient’s BP (blood pressure) is dropping.”

Tae-kyung, who was wearing a sterile surgical gown, ripped off the surgical drape covering the patient’s entire body.

“Defibrillator! Bring it here!”

The thunderous voice echoed in the emergency room.

“Hey! What are you doing! It’s over there!”

At the shout, a nurse brought the defibrillator, applied gel to the pads, and handed them to Tae-kyung.

Because the surgery had not yet been sutured, blood was pooling in the patient’s upper right chest.

The pooled blood flowed down the patient’s right neck.

The amount continued to flow like a shot glass of soju [Korean distilled liquor]. But there was no time to worry about this bleeding now.

The exact reason why the heart was suddenly fluttering was currently unknown, but the priority was to calm it down.

And the only way to do that was with a strong electric shock.

“Charge to 200J (joules, a unit of energy used to measure the electrical intensity of the defibrillator)!”

“Charged.”

Tae-kyung brought the defibrillator pads held in both hands to the patient’s upper left chest and lower right chest.

“One! Two! Three!”

At the same time as Tae-kyung shouted three, a strong electric shock was given to the patient.

Thump-

Due to the electric shock, the upper body muscles moved momentarily, and Oh Jae-bal’s upper body lifted from the bed.

“How’s the waveform? Is it coming back?”

Everyone held their breath and shifted their gaze to the electrocardiogram.

“No. It’s shaking again.”

“Do 200J one more time. Charge!”

“Charged.”

“One, two, three!”

Thump-

After the sound was heard again, Oh Jae-bal’s upper body heaved once more, and everyone looked at the electrocardiogram.

Then, the waveform, which had been shaking wildly like a tree branch in the wind, began to look normal.

“I-It’s back.”

“Yes. It’s back.”

“Professor, I’ll suture it.”

“Whew! Please do.”

Tae-kyung, who had weathered a stormy situation, let out a short sigh.

It’s been a long time since I’ve had such a difficult patient. When sepsis occurs, it puts a lot of strain on the body, so all kinds of complications can arise.

However, it is rare to have arrhythmias that require the use of a defibrillator.

Tae-kyung hadn’t seen Oh Jae-bal in a long time, so he didn’t remember exactly, but it would be reasonable to assume that the patient originally had an arrhythmia that was triggered by sepsis.

“I’ll redo the patient’s lab work. Please do arterial blood gas analysis every hour and send out follow-up labs every two hours.”

“Yes, Doctor.”

“If the patient doesn’t respond well to vasoconstrictors [medications that constrict blood vessels], we’ll consider dobutamine [a drug that increases the heart’s contractility]. And prepare epinephrine [adrenaline, a very strong vasoconstrictor] as well. Call the nephrologist [kidney specialist] because we might need to start dialysis [a procedure to filter the blood].”

“Yes, I understand.”

“Doctor, I think we’ve put out the immediate fire.”

Lee Chan-hee said, taking off his surgical gown after finishing the sutures.

“No. It’s just the beginning. We need to keep a close eye on this patient for the next five days. I’ll be watching closely, but Chan-hee, you need to check on the patient frequently as well.”

“Yes, I will.”

As Lee Chan-hee said, the immediate crisis was over.

Now, we need to move him to the intensive care unit and continuously manage the patient’s blood pressure, kidney function, liver function, lung function, and the extent of systemic infection with medication.

The reason is that the patient was in a condition where he could die at any moment, so we need to pay that much attention. Tae-kyung and the medical staff have to manage it well.

“Let’s walk this tightrope carefully.”

“Yes, Doctor, I’m really sorry, so sorry.”

Lee Chan-hee bowed his head 90 degrees like a sinner and apologized.

“I was careless. You always told me to take good care of critical patients, and even just now, you told me to pay attention to the patient and take more interest, but I didn’t see it properly under the excuse of being busy. I’m really sorry.”

Tae-kyung knew better than anyone that those words were not a lie.

Lee Chan-hee himself would be the most upset and angry right now. Moreover, since something similar had happened before, he must feel even worse.

Above all, as a fellow doctor and a senior, he also knew well the hardships of this path, where one must study and develop throughout their life for the sake of human life.

“Chan-hee?”

Tae-kyung lightly tapped Lee Chan-hee’s shoulder, who was bowing his head, as if to give him strength.

Rather than lecturing Lee Chan-hee, who had already been scolded severely, he wanted to give him strength.

“Look up.”

“Yes.”

“Is it tough?”

“Yes, no, I’m okay.”

“What do you mean okay? It’s tough. Chan-hee? Do you remember when you first started your clinical clerkship [the initial period of practical training for medical students]?”

“Yes!?”

Lee Chan-hee asked back, wondering what he meant by the sudden mention of ‘clinical clerkship’.

“During clinical clerkship?”

“Yes. When you were just starting your clinical clerkship, do you remember how you felt then?”

“…….”

“You examine patients directly while rotating through clerkships, using what you learned from professors through books. As you do that, you start thinking about the relationship between doctors and patients, listen more carefully to the patient’s small words, and want to solve their discomfort and pain, didn’t you?”

Lee Chan-hee, who was listening to Tae-kyung’s words, remembered himself at that time. It was a long time ago, but that period when he started his first clerkship was vividly clear.

In the neatly organized white coat pocket, he always carried a small spiral notepad and a pen.

That small notepad was already filled with dense letters in just one day.

He took notes diligently when the professors made rounds, but most of them were notes about the patients.

He wrote down all the patients’ complaints of pain and discomfort, even their mental grievances that were not related to treatment.

One day, a patient who was continuing treatment after surgery was constantly complaining of pain.

‘Doctor, I’m really in pain. Please take a look at me.’

The middle-aged woman was in agony every time he saw her. Seeing that, he wondered what it would be like if it were his own family.

After 고민 [agonizing/worrying] for a few days, Lee Chan-hee asked a senior doctor, but was ignored. So, despite the dissuasion of his group members, he went to the professor and asked him to examine the patient.

The professor was dumbfounded by the words of a fresh clinical clerkship student who was not even an intern, but he said he would.

It turned out that there was a mistake by the resident in charge of the patient.

‘What did you say your name was?’

‘It’s Lee Chan-hee.’

‘Thanks to you, the patient was able to get out of pain. You’ll be a good doctor in the future.’

The professor praised Lee Chan-hee sincerely and simply, and that day, that praise remained in his heart for a long time.

Thinking about it for a short moment now, he understood why Tae-kyung brought up the story of his clerkship.

Although he was still a student, it was then that he focused on patients more than ever, paying the greatest attention to their trivial and insignificant matters, and listening to them.

“Do you know why I asked you what you were thinking during your clerkship?”

Tae-kyung asked, looking at Lee Chan-hee, who was 곰곰이 [곰곰이 is a Korean word that means ‘deeply’ or ‘intently’] thinking.

“Yes, Doctor. I think you told me to focus more on the patient.”

“Yes, that’s right. That’s exactly it. That’s the method I’m using.”

It wasn’t just a nice thing to say to a junior, it was real.

Tae-kyung was also human, so there were many moments when he was exhausted. But whenever that happened, when he thought about the first time he went out on a clerkship, no matter how hard and tired he was, when he thought about that time, he could return to the 初心 [original intention/beginner’s mind] of a doctor who only thought about the patient.

“Chan-hee. Since the field we deal with is directly related to people’s lives, let’s be careful while thinking about our 初心 at that time.”

“Yes, Doctor. Thank you.”

“And you’re doing well. So, straighten your shoulders!”

“……!”

Lee Chan-hee was almost moved to tears by the unexpected comfort.

At the same time, the thought that he would never be able to meet such a teacher again no matter where he went made him feel desperate that he never wanted to disappoint Tae-kyung again.

“I will be more careful in the future.”

“Okay. I’m going up to the ward to see the patient, so Chan-hee, you stay by the patient’s side and control the blood pressure while adjusting the medications I mentioned earlier. If necessary, insert a central venous catheter [inserting a catheter near the heart through the chest or neck].”

“Yes, Doctor. I’ll take good care of the patient.”

“Okay, you won’t be able to sleep for about a week.”

“Yes, I know.”

“Ah! And you have to pump in fluids!”

“Yes.”

“Whew!”

Tae-kyung gave orders to Lee Chan-hee and left the emergency room, and only then did the tension that had been enveloping his whole body loosen. At the same time, thirst flooded his mouth.

“I’m thirsty…….”

He was so nervous that the patient might die that he had forgotten even the thought of drinking water and going to the bathroom.

“Ah! This water tastes amazing.”

Tae-kyung drank a full glass of cool water and headed to the ward again to see the patient.