Fifth Vital [EN]: Chapter 305

Vitality Five – Episode 306 (305/502)

Episode 306. One-Third Mark

“We have Our Hospital; would you like to go there?”

“Yes, please take me anywhere.”

The taxi driver set the destination on the navigation and headed to Our Hospital with the man.

The taxi left the apartment complex and drove down the road to its destination.

“Sir, we’ve arrived. This hospital has an emergency room.”

“Really? Thank you, driver. Take care.”

“Goodbye.”

“Haa!”

After paying the fare, the man took a deep breath and got out of the taxi, heading towards the emergency room entrance.

“Hello. Are you here to see a doctor?”

Since the emergency room wasn’t too busy, the man didn’t have to wait long before it was his turn.

“Yes, I’m here to see a doctor.”

“Please have a seat here first. What brings you in today?”

“No, I don’t need anything else. Just…”

“Please put one arm in here. I’ll check your blood pressure first.”

“I don’t need any of that. Just drain the fluid.”

When the nurse asked to measure his blood pressure, the man waved his hand in refusal and immediately stated what he wanted.

“Drain the fluid, you say?”

“Yes. I often get fluid drained when I go to other emergency rooms. I have cirrhosis [a chronic liver disease]. But today, I was nearby and got too short of breath, so I just came to the nearest place.”

“Ah, I see. Do you have any other underlying conditions?”

“I don’t need any of that… Just drain the fluid quickly. Haa! I can’t breathe.”

“I understand what you’re saying, but this is all for your benefit. Please understand that it’s necessary for the examination.”

Despite the man’s firm attitude, the nurse calmly continued to speak. It was best to soothe and respond to patients who were a bit older and stubborn like this.

Looking closely at the man, his arms and legs were thin, but his stomach was bulging. It wasn’t as noticeable when he came in because of his outerwear, but it was quite apparent up close.

“Sir, I’m going to ask you a few questions.”

“…”

“When were you diagnosed with cirrhosis?”

“…”

“Do you have any other underlying conditions?”

“…”

“Sir?”

“…”

“Sir, you need to cooperate.”

“You nurses sure talk a lot. Just drain the fluid.”

The patient didn’t seem to want to answer the nurse’s questions, perhaps because he was tired and irritable. He just seemed to want them to do what he wanted.

He didn’t pay attention to anything else that was said.

The nurse in charge was slightly annoyed at this point, but she tried not to be too shaken and responded, as these kinds of patients often came in.

“Sir, so you only want a paracentesis [a procedure to remove fluid from the abdomen]?”

“Yes. Just do that. That’s all I need.”

The man turned his head slightly, as if sulking at the nurse for not listening to him and continuing to ask questions.

“We need to do other blood tests and X-rays for your sake. You don’t want any of those things?”

“Ah! That’s what I’m saying! How many times do I have to say it? Just drain it quickly.”

“Okay, I’ll relay your wishes to the doctor. Please talk to the doctor when they come and wait a moment.”

The nurse decided not to continue the interview and decided to relay the situation to the doctor.

It was a wise decision. Since they hadn’t performed any tests yet, they couldn’t make any hasty judgments about the patient’s condition.

Promising to only drain the fluid in this state could potentially interfere with the patient’s subsequent treatment. Therefore, she passed the important decision on to the doctor.

“Intern, please guide this patient inside. I’ll call the doctor.”

“Yes.”

The nurse who was in charge of the man instructed a junior nurse and then called Lee Chan-hee.

-Hello, this is Lee Chan-hee.

“Dr. Lee, it’s the emergency room.”

-Yes, what kind of patient is it?

“It’s a liver cirrhosis patient who only wants fluid drained, and he’s being uncooperative and won’t answer any other questions.”

-What about tests?

“He refuses all other tests. He just keeps saying he doesn’t need them and to drain the fluid.”

-Did you do a blood test and X-ray?

“Not at all. The patient is being stubborn, so we couldn’t do it.”

-Sounds like today’s stubborn patient.

Lee Chan-hee didn’t think much of it, as a stubborn patient came in once or twice a day.

-If he refuses that much, there’s nothing we can do. I’ll have to go and drain it for him. I’ll be there soon.”

“Yes.”

Lee Chan-hee, who had been worrying about Choi Mona, decided to drain the patient’s fluid first, saying it as if it were nothing and hung up the phone.

“Please prepare for a paracentesis here.”

“Dr. Lee, it’s prepared next to the patient.”

Lee Chan-hee said as he entered the emergency room, and the nurse nearby immediately answered.

“Yes, thank you.”

Lee Chan-hee went straight to the patient, approached the man, introduced himself, and sat down.

“Hello, Mr. Go Myung-hwan. I’m Lee Chan-hee, the emergency room doctor in charge.”

“Yes, hello.”

“You’re here because you’re uncomfortable with the ascites [fluid buildup in the abdomen], is that right?”

“That’s right. I’m not going to do anything else. Just drain the fluid quickly.”

“Do you have something urgent to do?”

Lee Chan-hee, who had heard from the nurse that he was stubborn, didn’t try to be too forceful with the patient.

“Well… I don’t have much time. I hate spending time in the hospital.”

“What do you mean you don’t have much time?”

“If you look at my stomach… don’t you know?”

Even if Go Myung-hwan didn’t point to his stomach, Lee Chan-hee knew because he had seen his distended abdomen.

“Where were you diagnosed, sir?”

“…Yes, I know my condition well. Doctors want to do this and that, but I know it’s all useless in the end.”

“Still, wouldn’t you like to try a little more treatment?”

“…Treatment? I haven’t done anything for my children; how can I waste money at this age? I can’t do that.”

Go Myung-hwan, whose face was full of stubbornness, softened a little at the word ‘children.’

“Just disappearing quietly is the last duty of a father, that’s right…”

He answered quietly, but he couldn’t finish his sentence and turned his head halfway. He clearly had something he couldn’t say, but Lee Chan-hee didn’t bother to ask.

“Doctor, please drain the fluid.”

“Okay. Then I’ll drain the fluid. You know how it is since you’ve done it so many times, right? Don’t move, and don’t touch anything we’ve secured.”

“Of course. It’s not like I’m doing this for the first time; I know it well.”

“Okay, then let’s get our patient ready.”

As soon as Lee Chan-hee finished speaking, Go Myung-hwan loosened his pants buckle as if he were used to it and lowered his pants to his hips. He also raised his top appropriately to expose his stomach enough for the doctor to touch.

“It looks like you’ve done this many times, seeing how you’re preparing.”

“Yes, I’ve done it a lot.”

Lee Chan-hee struck up a simple conversation to ease Go Myung-hwan’s tension and then glanced over his bulging stomach.

He checked for any abnormalities with visual inspection, but he couldn’t see any blood vessel proliferation due to cirrhosis yet.

However, there was a small surgical scar. Lee Chan-hee tapped the patient’s abdomen and checked how much fluid there was.

Tung, tung, tung.

‘It’s very full.’

Anyone could feel that the abdomen was full of fluid. In this case, the doctor feels relieved.

In this case, the fluid is so full that it will come out no matter where you poke it.

Of course, there is a safe point, and you have to poke around it.

Lee Chan-hee touched Go Myung-hwan’s left pelvis and then touched the most protruding part.

You should mainly poke around that area. Lee Chan-hee touched the left pelvis and then touched the most protruding part.

This part is the ASIS (anterior superior iliac spine) [the bony prominence at the front of the hip], which is the standard for selecting the location for paracentesis.

Draw an imaginary line from here to the navel and divide it into thirds. Then, press down on the lower 1/3 point with your fingernail to leave a slight mark.

‘This should be enough.’

Lee Chan-hee had performed this procedure hundreds of times on patients who came to the emergency room or outpatient clinic.

Therefore, he didn’t think it was a big deal and wasn’t very nervous. That’s because he had a lot of experience and nothing had happened so far.

Lee Chan-hee, who had pre-cut a long piece of tape, put on disposable sterile gloves to prevent contamination and disinfected the area around the fingernail mark by drawing a circle with a povidone-soaked cotton swab.

Then, he covered it with a fenestrated drape (a sterile drape with a hole in the center where the procedure will be performed).

He picked up a needle about 5 cm long and a catheter of similar thickness that surrounded it (a flexible plastic that surrounds the needle and enters the blood vessel or abdominal cavity along the needle. The end is blunt so it does not damage other organs). Then, he inserted it into the abdomen at a right angle to the abdominal surface or at an angle suitable for the operator’s judgment.

“Ugh!”

Soon after, a yellowish fluid came out through the catheter along with Go Myung-hwan’s short, painful sound.

‘Good.’

After confirming that the fluid was coming out, Lee Chan-hee skillfully connected the line and hung it on the entrance of the fluid collection container on the floor.

“Okay! The fluid is coming out well now. We’ll change the container as soon as it’s full. We can’t take out too much, so we’ll proceed while checking the amount and measuring blood pressure.”

“Yes…”

Whether it was a feeling or just his imagination, Go Myung-hwan’s answer didn’t sound right, but Lee Chan-hee didn’t pay much attention and checked again before heading to the station.

After that, he saw other patients and went to see a patient after receiving a call from the ward.

After resolving the emergency call, Lee Chan-hee took a look at the other patients while he was up there.

“Grandpa, this is the last time. If you keep touching the bandage, I’ll call the director.”

“Dr. Lee, I really did it by mistake this time. I’m sorry. I won’t do it again.”

“Is the director that scary?”

“Of course. He told me that if I don’t listen to the doctors, he’ll send me to another hospital, and I don’t want to go to another hospital.”

“Then don’t make the nurses’ job difficult.”

“Okay. I’ll keep that in mind.”

“Then rest well.”

“Okay. Dr. Lee, I don’t know what’s going on, but cheer up. Nothing will work out if you work with that face.”

“Yes.”

“Dr. Lee, are you making rounds?”

Lee Chan-hee, who was responding to the patient’s words with a bright smile and leaving the hospital room, ran into Dr. Euijin, who was coming out of another hospital room.

“I took a round while I was here for the call.”

“Did you come to the ward?”

“Yeah. Want a coffee from the vending machine?”

“Sure.”

The two of them got coffee from the vending machine in the ward lounge.

“So, what’s bothering our Dr. Lee?”

“Excuse me?”

“The patient in room 304 told you to cheer up a while ago.”

“Did you hear that?”

“He said it very loudly. I was going to ask you too because your expression hasn’t been good since you came to work.”

“Is my expression that bad?”

Lee Chan-hee, who was holding the coffee, asked while looking at his face reflected in the lounge window.

“Yeah. It’s completely dead, just like the patient said. What’s wrong?”

“It’s not a serious matter.”

“It’s not a serious matter, but something’s going on.”

Lee Chan-hee thought to himself.

The staff at Our Hospital were all on good terms, but Euijin, nurse Lim Jung-sook, and Choi Mona were especially close.

Therefore, he thought that Euijin would know why Choi Mona was so dressed up today.

“Actually, doctor…”

Rrrrrrrrrrrr

Just as he was about to ask the reason, the cell phone in his gown pocket rang quickly.

“Hold on a second. Hello, this is Lee Chan-hee.”

-Dr. Lee. It’s about that ascites patient.