Fifth Vital [EN]: Chapter 240

Fifth Vital Sign – Episode 240 (240/502)

240. Spot the Difference

“Hello.”

Kim No-dam, who was about to explode with curses, turned toward the gentle voice.

“Hello. Patient’s family.”

Tae-kyung, entering the emergency room, greeted Kim No-dam with a calm and gentle expression.

“Is there a problem?”

“Ah! Just looking at you. You must be the director here, right?”

Kim No-dam sized Tae-kyung up, recognizing him.

“Now that I see you, you’re that famous director from TV. Kim Tae…kyung, isn’t it?”

“Yes, that’s correct.”

“Good. You finally show your face. Hey, can I say something?”

“Of course. Go ahead.”

“This doctor here initially said there was nothing wrong. Then, when my wife kept saying she was in pain, he didn’t even bother to check, but suddenly he pokes her stomach a few times and says we need surgery. Does that make any sense? Huh? Is this just a money grab?”

“It seems you’re understandably upset. If you don’t mind, I’d like to explain everything step by step?”

“Alright. Explain away.”

Kim No-dam crossed his arms, daring him to try.

“It’s true that Lee Han-soon’s CT scan didn’t show any immediate issues. So, we were initially relieved.”

“And?”

“So, the initial plan was to simply suture [stitch] the wound on her abdomen and be done with it. However, the doctor here wanted to be cautious and observe her a little longer.”

Tae-kyung gestured to Lee Chan-hee, who was standing nearby, and continued.

“Even if there’s internal organ damage, it might not always be visible on a CT scan right away. Or, it could have been normal during the scan, but the organ contents could later leak through a weakened area. Also, we intentionally avoid giving painkillers to patients complaining of abdominal pain so we can accurately monitor their condition.”

“Why is that?”

“Because it’s not practical to do CT scans constantly. We track the illness by observing whether the patient’s symptoms worsen. Of course, it’s our fault for not providing these explanations each time your wife reported pain. But that doesn’t mean we harmed her in any way. In fact, we’re following the most appropriate treatment protocol.”

“Then… what I’m saying is, why the sudden need for surgery?”

As the calm explanation continued, with Tae-kyung making eye contact, Kim No-dam’s expression and tone softened.

“Right now, there’s visible irritation on the abdominal wall during the physical examination. This suggests possible organ damage, requiring immediate surgery to locate and repair it. That’s why surgery is necessary.”

“Sewing up the organs inside? You mean, the actual organs?”

“Yes, of course. Otherwise, the contents will continue to leak, making the situation worse.”

“So, you’re opening up her belly? What was it called again? Bo, bo something?”

“Laparoscopy [a minimally invasive surgical procedure]?”

“That’s right. Can’t you do it with that laparoscopy?”

“It’s possible, but not ideal for the patient in this case. This surgery isn’t targeting a specific problem; it’s an exploratory procedure to diagnose and treat any abnormalities we find. It’s called an exploration. Laparoscopy would take longer and make it harder to locate the damage.”

“…….”

“Sir, I understand your emotions are heightened because of your concern and love for your wife.”

“Ah, yes. Well, because I’m her husband…….”

Kim No-dam, and even Lee Han-soon, who was lying on the bed in pain, seemed surprised to hear the word ‘love’.

Tae-kyung used the word ‘love’ intentionally for the couple to hear.

While walking from the staff cafeteria to the emergency room, he’d overheard from Nurse Lim Jeong-suk that the two had a fight, and the wife had harmed herself.

So, Tae-kyung deliberately mentioned ‘love’ to the husband.

People with those tendencies are often surprisingly simple.

Not all of them, of course, but those who use sharp and rough language often become gentle when praised.

It was a pattern he’d observed through years of hospital life and dealing with different people.

Getting into the operating room quickly to assess the patient was crucial. So, creating a good atmosphere and preventing further conflict was the priority.

If emotions flared up again, it wouldn’t be good for the patient or the medical staff.

“Please remember that we always make the best decision for the patient. Can I get your signature on the surgery consent form?”

“Ah, yes. Go ahead. Honey, should we listen to the explanation? What do you think?”

“Well, we should listen.”

“Be, be careful getting up.”

“I’ll guide you.”

In reality, Lee Chan-hee didn’t fully grasp Tae-kyung’s explanation.

To be honest, he’d been so busy that he’d overlooked it because the CT scan showed no abnormalities until Tae-kyung advised him over the phone.

“I feel unnecessarily guilty… But since it’s working out, I need to be more careful next time.”

“I can hear you.”

Choi Mona, who was checking on a patient nearby, overheard Lee Chan-hee’s mutterings and added a comment.

“Your interpretation was bigger than the dream, but it’s fortunate that the interpretation was good.”

Choi Mona understood Lee Chan-hee’s inner thoughts, unlike the other medical staff.

“Hey! Be quiet, they’ll hear you.”

“Whatever!”

“Chan-hee?”

“Ah, yes. Doctor.”

Meanwhile, the guardian and patient finished signing the surgery consent form at the emergency room station, and Tae-kyung approached.

Fortunately, the stubborn patient agreed to surgery after her husband persuaded her.

“Tell Doctor Jung, and let’s head to the operating room immediately. No point in wasting time. Let’s get it done.”

“Yes, I understand.”

After that, the surgery preparations proceeded quickly, and Tae-kyung entered the operating room with Lee Chan-hee.

“Alright! Let’s start right away. Scalpel.”

As the scalpel was handed to Tae-kyung, Lee Chan-hee pulled the skin of the upper abdomen to both sides.

“Chan-hee, the incision line should naturally extend from the wound.”

“Yes, Doctor.”

Tae-kyung made a deep incision from the lower end of the self-inflicted wound.

Due to the clean incision, the patient’s abdominal skin was fully opened, revealing the inside of the abdomen with a Bovie [electrocautery device].

“First, let’s check for any obvious abnormalities.”

The first step was to check for any damage along the path of the stab wound.

Since the patient stabbed herself, they needed to examine each part, starting with the outermost layer of the abdomen, the mesentery [a membrane that holds abdominal organs in place].

The mesentery, a long, fatty membrane, contains blood vessels like spiderwebs, so damage could cause problems.

Tae-kyung carefully examined the mesentery, inch by inch, using his thumb and index finger.

He moved 5cm at a time, meticulously checking for anything he might have missed.

The stab wound was about halfway between the navel and the sternum [breastbone].

The organs along that path needed to be checked. It was obvious. However, Tae-kyung meticulously examined the entire outer surface of the mesentery.

“Hmm……. Wait a minute. Haa!”

Tae-kyung seemed concerned.

“I don’t see anything strange. Doctor Lee, do you see anything?”

“Yes? No. How could I see something you can’t?”

“No. This… it’s not about medical skill. Chan-hee, have you ever played spot the difference?”

“Of course. I’ve played it before.”

“This is like that. It’s a kind of spot the difference.”

“Spot the difference?”

“That’s right. It’s easy to miss. So, we have to look carefully. You look carefully to find the differences. There’s not much difference between you and me right now.”

He was right.

In this surgery, determining whether there was an abnormality, the most important initial goal, had nothing to do with medical skill.

Wound!

Finding an unusual area was literally like spotting the difference in the organs.

“Let’s see……. The mesentery is done, now it’s the small intestine.”

He examined the small intestine beneath the mesentery.

“Hmm! That’s strange…….”

“It seems normal.”

Lee Chan-hee replied, puzzled by Tae-kyung’s words.

“Still, let’s look at everything one by one.”

“Yes.”

Kim Tae-kyung began to check not only the small intestine under the stabbed area but also every inch of the small intestine from its beginning.

Holding the small intestine 10cm at a time, the two of them stared intently.

It was beyond meticulous; it was excessive. This wasn’t just because Tae-kyung was naturally careful.

“I’m sorry, Doctor. I shouldn’t have misjudged…….”

After looking so carefully and finding nothing, Lee Chan-hee thought he’d made a mistake. He felt guilty for making things more complicated.

“No. That’s not it.”

“Yes!?”

“There’s no reason to apologize. I saw the patient and her condition. There’s definitely organ damage, but we can’t find it.”

It wasn’t just stubbornness; it was a medical conviction based on experience. Lee Chan-hee knew this better than anyone, so he silently watched Tae-kyung.

‘No. There’s definitely something wrong.’

And above all, the third-stage smell of the fifth vital sign that he’d sensed from Lee Han-soon in the emergency room still lingered.

It was as if the smell was teasing him, playing tag.

“Hmm……. The small intestine is normal too.”

“…….”

“Well, shall we look at other places now?”

“Yes? But aren’t the other organs too far from the stab wound?”

“I know.”

Tae-kyung knew it well. But he had no doubt about his conviction. So, he decided to look at other places.

The two began to examine the large intestine.

Tae-kyung put both hands into the abdomen and lifted one side of the abdominal wall, including the skin, fat, and muscles, about 3-5cm thick.

To explain the abdominal wall simply, imagine a blanket on top of another blanket, and another on top of that, all attached.

Lifting all those thick, combined blankets was like lifting the abdominal wall. It was that heavy.

“Chan-hee, look!”

“Yes?”

“See if the large intestine on my side is okay. It’s heavy. Look quickly.”

“Ah! Yes!”

“No, move the intestines with your hands and turn on the light to see!”

Tae-kyung, pulling with all his might, his hands shaking slightly, urged him to hurry. It was heavier than he expected.

“Yes!”

Only then did Lee Chan-hee put both hands in and carefully examine the small intestine and the right large intestine.

“How is it?”

“It seems fine.”

“One more time, no. Look twice!”

“Yes!”

“No abnormalities?”

“No.”

“Hoo! Okay, lift it!”

“Ah! Yes! Ack! It’s heavy.”

“That’s going to be a little heavy.”

Lee Chan-hee lifted the abdominal wall as Tae-kyung had done.

This time, Tae-kyung’s hands went into Lee Han-soon’s abdomen. He moved the small intestine and carefully checked the large intestine from the top.

“No abnormalities! Okay, let’s close it now.”

After searching meticulously and finding nothing, Tae-kyung finally decided to finish.

“Haa! That’s strange.”

He felt a disturbing sensation, the first in a long time, perhaps the first time in the operating room.

“What should we tell the patient?”

“There’s no choice. We have to tell them there’s a possibility of reoperation later.”

“That’s really strange.”

“Maybe it wasn’t a wound that we could confirm…….”

Of course, that was possible. Besides, the organs were intact, no matter how much they checked.

‘Did I misread it? Is this the first time I’m wrong?’