Fifth Vital [EN]: Chapter 247

“Stapling the stomach and small intestine isn’t the end. You need to suture them twice more.”

“Yes, Doctor.”

“Give me the CR (curved round needle holder, an instrument for laparoscopic suturing).”

The nurse loaded a suture needle into the CR instrument, which resembled a sword, and handed it over. The CR has a sword-like handle with a long, round neck and a 1cm clamp at the end to hold the needle.

The reason it has a sword-like handle is to allow the wrist to rotate during suturing.

It sounds easy, but actually suturing laparoscopically to the desired depth with the desired strength is quite difficult.

Even among surgeons, considerable laparoscopic experience is necessary.

Of course, it was something Dr. Tae-kyung, with his extensive experience, could easily do.

With skillful speed, he sutured along the cut and stapled surface of the stomach, stitch by stitch, using the CR.

He proceeded with the suturing to the desired depth in the desired location. He carefully tied each stitch and repeated the process.

The stomach is a muscle mass, so it doesn’t tear easily even if sutured strongly, but the sutures are more likely to come undone due to stomach acid, so the stomach mass must be pulled together and sutured once more.

The second suture involves inserting the needle into the outer surface of the stomach, overlapping the stomach tissues on both sides of the cut surface.

“Okay! Give me the bag.”

A bag was inserted into the abdomen, opened, and the lower part of the cut-off stomach was placed inside.

A portion of the stomach, about the size of an adult’s palm, was placed in the bag.

Afterward, Tae-kyung further incised the trocar site [small incision] where the camera had been inserted, creating a hole about 4cm in diameter.

Then, he pulled the bag with all his might, and the stomach and bag came out through the hole in the abdomen.

As always, Fifth Vital was very honest.

‘That’s it!’

The moment the stomach cancer part came out of Hamad’s body, even the severe, stage 3 fecal odor vanished.

“Okay! Specimen out.”

Tae-kyung walked to the pre-prepared sterile table and opened the bag, placing the stomach removed from Hamad’s body onto it.

Afterward, he cut the stomach with scissors to check if the cancerous part was well removed, then thinly sliced the cut surface with sterile scissors and placed it in a bottle filled with water.

“The cut specimen will go out for frozen section (a pathology test performed rapidly during surgery; if cancer cells are present, the remaining tissue must be resected).”

As Tae-kyung returned to the operating table where the patient was lying, the nurse naturally handed him the grasper.

He inserted the instrument into the abdomen and pulled the small intestine to the remaining part of the stomach. Now it was time to connect the remaining part of the stomach to the small intestine.

A 0.5cm hole was made in the small intestine with an electrocautery device, and a hole was also made in the remaining part of the stomach. Then, both sides of the GIA stapler [Gastrointestinal Anastomosis stapler] were inserted into the holes in the stomach and small intestine, respectively.

This brings one side of the small intestine into contact with the remaining part of the stomach. Activating the device creates a hole between the small intestine and the remaining part of the stomach.

The connection between the small intestine and the stomach around the hole is fixed with numerous staples.

“Okay, give me the CR.”

Even with the advent of the very useful stapler, the final step always requires suturing.

Rotating his wrist here and there, he sutures the front and back of the approximately 10cm anastomosis [surgical connection], stitch by stitch.

The act of bending the wrist and coming out to the other side at the appropriate depth is repeated.

Tae-kyung was performing laparoscopic suturing, which most surgeons cannot do, with such ease.

‘How much experience and practice do I need to do to be like Dr. Kim?’

“Director?”

While Lee Chan-hee was thinking to himself while watching Tae-kyung’s suturing, the nurse spoke.

“We received a call from pathology; the frozen section is negative (meaning there is no cancer in the specimen examined by rapid freezing).”

“Good. Okay! Let’s close the small intestine and finish.”

If the small intestine is pulled up and connected to the stomach, other parts of the small intestine can crawl into the gap created. Therefore, this space between the small intestines must be meticulously filled with sutures.

After pulling the small intestine out again through the 4cm hole, the space between the small intestines is closed with surgical ties to prevent it from opening.

“Chan-hee?”

“Yes, Doctor.”

“Try it once.”

“Y-Yes?!”

Lee Chan-hee, who had been answering mechanically, understood the meaning of the question and asked back.

“M-Me?”

“Why are you so surprised? Why? Don’t you want to?”

“No, not at all. No. I’ll try.”

“Okay. You’ve done it a lot before. Just do it the same way.”

“Yes.”

Lee Chan-hee calmed himself and tied each tie as he had practiced.

Tae-kyung knew better than anyone how much Lee Chan-hee had practiced. And now he also knew that his junior could do ties to some extent. However, he had not given him the opportunity to do ties because of his perfectionist personality.

“You’re a bit clumsy, but you’ve practiced a lot, haven’t you?”

Tae-kyung, watching Lee Chan-hee, said, hiding a pleased smile behind his mask.

“Thank you.”

“Okay, I’ll leave it to you now.”

“Yes?”

“Keep tying.”

“Ah, yes. I understand.”

“A little weaker than now. You’re putting too much force in it now. The small intestine will tear. Relax.”

“Yes, Doctor.”

“The knot should go in a little softer. A little softer, but you don’t have to do it slowly. That’s it. Just relax. Good.”

Tae-kyung did not hold back on teaching his junior. Lee Chan-hee, encouraged by Tae-kyung, concentrated on finishing the ties.

“Okay! That’s all done. Now, let’s just close the abdomen.”

With the ties finished, Tae-kyung closed the abdomen layer by layer, as in a typical surgery.

Since the abdomen was not incised more than 4cm, the closure was also completed quickly.

With this, all of Hamad’s surgery was finally over.

“Everyone, you’ve worked hard.”

“Thank you for your hard work.”

“I’ll write the records and be in the waiting room. Call me when the patient wakes up.”

“Yes, we’ll call you when the VIP wakes up.”

“Ah! That’s right. VIP. I forgot.”

Tae-kyung, focused on the surgery, had forgotten that the patient was Hamad.

“Doctor, how could you forget that? It’s our hospital’s first VIP patient, you shouldn’t forget.”

As Lee Chan-hee spoke to Tae-kyung, who was leaving the operating room, Ui-jin shook his head and answered instead.

“Rather, it’s probably because all patients are VIPs to Dr. Kim. Everyone is an equal and important patient, so he probably didn’t think of Hamad as more important. He probably did his best, just like when operating on other patients.”

“Well, Dr. Kim is the kind of person who would do that.”

Tae-kyung, who came out of the operating room, went straight to the guardian waiting room.

“Assemblyman?”

“Director!”

Instead of Hamad’s family, Gam Deok-chan was in the waiting room.

“How did it go?”

“You were worried, right? The surgery went well.”

“Haha! I knew it.”

At the news that the surgery went well, Gam Deok-chan and the translator next to him were relieved with bright expressions.

“Actually, I wasn’t even worried…”

“Excuse me.”

That’s when Gam Deok-chan was about to continue speaking with a bright expression.

“Excuse me.”

Several middle-aged men in neat suits hurriedly entered the waiting room with the sound of shoes.

“Oh, Secretary Go?”

“Assemblyman Gam, hello. We meet again.”

The man who came in at the forefront seemed to know Gam Deok-chan.

“But what brings you here?”

“I came because of Mr. Hamad.”

“Mr. Hamad?”

“Yes.”

“Let’s introduce ourselves first. This is the director of our hospital and Mr. Hamad’s attending physician, Director Kim Tae-kyung. Director, this is Secretary Go Young-ho and his staff from the Presidential Secretariat [Office of the President].”

The person Gam Deok-chan introduced was none other than a secretary working in the Presidential Secretariat.

“Hello, Director. I’m Go Young-ho.”

“Kim Tae-kyung.”

“Director, did the surgery go well?”

“Yes, the surgery went well.”

“Then, without wasting any time, I’ll get straight to the point. I’m sorry to bring this up so suddenly, but I’d like to transfer Mr. Hamad to another hospital.”

“Yes? Transfer?”

“Secretary Go, what are you talking about?”

“There were instructions to move the VIP to a more comfortable and better hospital.”

Hamad, who had signed an important contract with the government a few days ago, was literally a VIP from the government’s perspective.

However, because Hamad had kept the surgery a secret from everyone except Gam Deok-chan, government officials only learned about his surgery today.

Those at the top seemed displeased that Hamad had undergone surgery in a small, out-of-the-way hospital when there were many large and well-equipped hospitals in Seoul.

They wanted to move him to a better hospital in case it later led to a diplomatic issue for not properly treating a VIP.

“So, we’re going to move Mr. Hamad to another hospital. I hope you understand, Director.”

“Hey! Secretary Go, even so, this is not right, is it?”

Gam Deok-chan said, as if he was dumbfounded.

“Well, I can’t interfere with what the government does as a mere doctor.”

“No, Director, why are you saying that? You know very well how Hamad came to you.”

Gam Deok-chan was slightly taken aback when Tae-kyung spoke nonchalantly, when he expected him to get angry.

“Thank you for understanding.”

“No, well, I’m just understanding. But can I ask you something?”

“Yes, of course.”

“Did Mr. Hamad agree to this?”

“…Yes?”

“No, not ‘yes,’ but I’m asking if my patient knows about and has agreed to the hospital transfer after the surgery.”

“Ah! That’s…”.

At Tae-kyung’s words, the secretary trailed off and once again emphasized who he was.

“Director, I don’t think you know how important this matter is, but I and the people here are government officials.”

“I know that because you said it earlier, you don’t have to emphasize it so much. I can’t tell the government not to do what it’s doing.”

“Now you’re talking some sense.”

“However, Mr. Hamad is my patient. As the attending physician, I cannot approve a matter that has not been discussed with the patient himself. I don’t know what you think, but it’s the same even if someone higher than the secretary comes.”

“… !”

“Besides, the patient came all the way to me to receive surgery and treatment.”

“We know that very well.”

“Anyway, I can’t just send a patient like that without any consultation. If you really want to transfer him, talk to Mr. Hamad directly.”

“Listen, Director. I don’t think you know what kind of situation this is.”

The secretary, who was flustered by Tae-kyung’s clear words, raised his voice, and immediately after, a louder voice was heard.

“STOP! STOP!”

It was Hamad’s aide, who had left his seat to talk to his home country.

The aide was the same one who had raised his voice to Tae-kyung on the day Hamad first visited the hospital.

He was the highest-ranking among the aides.

As the atmosphere turned strange, the translator, who had left the waiting room, quickly went to the aide and conveyed the situation.

“What is going on here?”