Fifth Vital [EN]: Chapter 488

489. Like the Surface of an Ostrich Egg

‘Ah! I messed up with my words.’

I was trying to appear as a patient injured in a traffic accident, but I blurted something out without thinking.

Moreover, I didn’t just say I was in pain; I even groaned about a headache, fully committing to the act.

But here’s another big problem. In the emergency room, they draw blood for basic tests.

Immajun, feeling guilty as a thief, was afraid his drug use would be detected. So, he came up with something: ‘needle phobia.’

‘Patient, we need to draw blood for tests.’

‘I can’t have blood drawn right now.’

‘Excuse me?’

‘I… I have a needle phobia.’

Immajun lied to the medical staff trying to examine him.

He even babbled about feeling dizzy and scared at the thought of getting blood drawn because of his needle phobia.

Since needle phobia is a real condition, though rare, the medical staff advised him to lie down and rest.

Because of that, Immajun was stuck in the bed, unable to do anything.

‘Check on patient number 13.’

‘Yes.’

Hearing the nurse’s voice from beyond the curtain, Immajun quickly lay down and pretended to sleep.

*Chareuk-*

‘Patient!?’

The nurse, opening the curtain, carefully called out to Immajun, who was still lying with his eyes closed.

‘Excuse me, patient?’

‘……Yes?’

Immajun slowly turned his head and opened his eyes, pretending to be weak, as if he had just woken up.

‘We need to proceed with the tests. Are you feeling okay?’

‘I’m still a bit tired. Can I lie down a little longer? I think I’ll be okay soon.’

‘Okay. I understand. I’ll come back later. If you feel any discomfort, call us immediately.’

‘Yes, thank you.’

In the end, Immajun made another excuse and lay back down on the bed. He started racking his brain about how to get through this situation.

* * *

Lee Jungbon, transferred to the operating room, was anesthetized by the anesthesiologist, Lee Donghoon.

Soon after, Taekyung entered the operating room.

‘Patient’s condition is stable?’

‘Of course, Director. Please proceed with the surgery with peace of mind.’

Taekyung asked, and Lee Donghoon, who was watching the monitor, answered energetically.

‘Today, we’re performing a Total Hip Replacement (THR) [a surgical procedure to replace a damaged hip joint with an artificial one]. It’s different from the surgeries we’ve done frequently, and there will be a lot of bleeding due to the nature of the surgery, so I need everyone’s cooperation.’

‘Yes, Director.’

Announcing the start of the surgery, Taekyung laid Lee Jungbon on his side so that his injured pelvis was facing upwards.

Pelvic trauma surgery is a bit different from other surgeries.

Abdominal surgeries use laparoscopes [a surgical procedure performed through small incisions with the aid of a camera] to avoid blood vessels or directly tie off blood vessels to stop bleeding.

And most orthopedic surgeries use a tourniquet [a device used to compress a limb to restrict blood flow] to completely block blood flow.

Pelvic surgery can’t do either.

The blood flowing to the pelvis branches directly from the aorta [the main artery carrying blood away from the heart], and there’s no place to apply a tourniquet, so it can’t be blocked from the start. Also, due to the nature of trauma surgery, it’s impossible to stop the bleeding while proceeding.

In conclusion, it means the surgery will inevitably involve a lot of blood loss.

‘Alright! Let’s position the patient first.’

‘Yes, Doctor.’

The surgery Taekyung was about to perform was completely different from the surgeries he had done before, and it was a new surgery that he wouldn’t do often in the future.

So, unlike the way he used to educate his juniors in the operating room, he decided to concentrate on the surgery himself.

Taekyung lifted Lee Jungbon’s chest, whose limbs were limp from anesthesia, and turned him to the side.

‘Bring any of the fixing devices and cotton.’

‘Yes, Director.’

When Taekyung asked for the devices used in urology, the staff brought the fixing tools used during urological surgeries.

‘Here are the devices and cotton.’

Taekyung looked around and installed the devices on the operating table to hold the patient’s body from the front and back. And he rolled up cotton to cushion the space between the devices and the patient’s body.

‘Alright! Povidone [an antiseptic used for skin disinfection].’

‘Yes.’

Taekyung, holding cotton soaked in povidone, disinfected from the center of the patient’s pelvis outward in a circular motion.

He stopped disinfecting after sterilizing most of the thigh up to just below the chest. Then, he silently washed his hands and returned to his place.

It was the same gowning as usual, but everyone in the operating room, including Taekyung, felt tense because it was a completely different surgery.

It wasn’t a surgery involving torn organs or serious pathological conditions, but everyone gets nervous during any surgery.

Moreover, it was the first hip replacement surgery with our hospital staff, so it was natural for everyone to be nervous.

Soon after, a large sterile drape was placed around the patient’s pelvis, exposing only the pelvis.

Normally, it would have ended here, but Taekyung didn’t stop there.

He took out an orange sterile vinyl.

He carefully wrapped the patient’s pelvis with the sterile vinyl, as if wrapping food.

‘Because it’s orange, it looks like…’

‘You thought it looked like food packaging, right?’

‘Yes. But Doctor, why are you doing this?’

‘Blood doesn’t flow well to the bones, so even if you take or administer antibiotics, they don’t reach the bones well.’

‘So, is it because of infection?’

‘That’s right. It’s because of infection. So, once infected, it’s mostly incurable and causes lifelong suffering. Moreover, when inserting artificial joints like now, the stakes are much higher. If an infection occurs, all these joints must be removed, and the patient has to fight pus for the rest of their life.’

‘Fighting pus for the rest of their life sounds horrifying just thinking about it.’

‘Of course. We’re doing surgery to live comfortably, but if something like that happens due to surgery, it would be terrible for the patient.

So, some hospitals in the United States proceed with joint replacement surgery wearing protective clothing. They are thoroughly careful to prevent the patient from getting infected.’

Taekyung covered the surroundings with orange sterile vinyl and continued.

‘This vinyl sticks to the skin and prevents skin flora [microorganisms that live on the skin] from spreading. Sterilization is important, but maintaining a sterile state is even more important.’

‘The orange vinyl plays a very important role.’

‘That’s right. The power of this vinyl is stronger than you think. Okay, anesthesiologist, let’s start the surgery.’

‘Yes, Director. Please begin.’

With all preparations completed, the surgery finally began.

Taekyung makes a long incision on the patient’s injured pelvis with a scalpel.

As the scalpel cuts through the skin, fat masses appear that are incomparable to those in the abdomen.

At the same time, blood flows profusely, dyeing the yellow fat red.

Lee Chanhee, in the assistant position, quickly wipes away the flowing blood with gauze.

Taekyung fearlessly cuts down with a Bovie (electrocautery device) [a device that uses heat to cut tissue and stop bleeding]. After going down a bit, a red muscle mass appeared.

Taekyung pinched the muscle slightly with one hand and incised it with the Bovie, and the outermost muscle was completely incised, revealing the middle layer of the gluteal muscle [buttock muscle].

‘Oh! It’s quite smooth.’

Lee Chanhee, seeing the gluteal muscle for the first time, said as if amazed.

It was smooth enough that anyone seeing it for the first time would think so. It’s a smooth, large, and round muscle, like the surface of an ostrich egg.

If anyone saw this scene now, they would undoubtedly call it a red ostrich egg.

Taekyung casually grabbed the muscle with his left hand and cut it down with the Bovie without hesitation.

The operating room was filled with the smell of burning, and the head of the femur (thigh bone) [the long bone in the upper leg] was visible from the deeply cut pelvis.

The innermost muscle of the gluteal muscle is attached to this bone, so the bone and muscle are separated one by one with the Bovie.

To explain Taekyung’s current work easily, think of it as separating the muscle with the Bovie, like scraping a fossil from the ground.

After separating everything, the head of the femur, the size of a child’s fist, was revealed.

‘Hmm……’

Taekyung, looking at it, made a thoughtful expression and stared intently for about 3 minutes. Then, the eyes of the operating room staff, including Lee Chanhee, were all focused on Taekyung.

The nickname of orthopedic surgeons is carpenters.

This is because understanding the mechanical relationship that is visible rather than the physiological understanding inside the body and creating structures is similar to carpentry.

Hip replacement surgery is especially so.

Taekyung picks up the artificial joint to be implanted in the patient and puts it on the thigh.

The sight looked like a designer or tailor.

‘Doctor, excuse me, but what are you doing?’

Lee Chanhee asked.

In fact, if this was a university hospital and not our hospital, it would be impossible for an assistant to ask a professor about the surgical steps.

Lee Chanhee knew that fact well. But this is not a university hospital with strict rules.

Of course, in the operating room, all medical staff holding the patient’s life in their hands must be tense and strict. That’s the same in our hospital’s operating room.

However, Taekyung is tense and strict in the operating room, but he always answers questions from his juniors as long as it doesn’t interfere with the surgery.

In fact, Lee Chanhee will not be performing orthopedic surgery, but he decided to answer in case a patient who needs the same surgery comes in the future.

‘Now, we’re replacing this big head bone between the thigh and pelvis with an artificial bone……’

‘Ah, is this being replaced?’

Lee Chanhee looks at the artificial bone made of metal as if it were amazing.

‘But it’s a bit smaller than the patient’s bone and the end is thin.’

Think of the artificial bone as a period mark [full stop] that we commonly know. It looks like a big period mark.

‘Shouldn’t it be the same shape as the thigh bone to replace it?’

‘Lee, didn’t you see this surgery when you were a student or intern?’

‘No…… I didn’t have a chance to see it.’

‘Yes, that’s possible. Chanhee, it’s your first time seeing the surgery, so that’s understandable, but if you replace this big femur (thigh bone) on your thigh, what about the ones on your knees and what about the ligaments? Of course, you can cut the top of the bone and insert it.’

‘Ah, are you cutting the thin part here and inserting it into the bone? Wow, that’s completely construction.’

To Lee Chanhee, who majored in GS [General Surgery], orthopedic surgery was always amazing to see.

‘That’s why they call orthopedic surgery carpentry.’

Every time Taekyung performs hip replacement surgery, he thinks it’s similar to grafting a tree.

Cutting the existing tree, pushing in new branches, and fixing them is exactly the same.

Taekyung talks to Lee Chanhee, puts the bone on it, and engraves the design line on the bone with the Bovie. And he picked up a gun-shaped device with a saw at the end.

Normally, the nurses would have given it to him, but everyone is unfamiliar with the surgery for the first time and doesn’t know the names of the instruments.

Because of that, Taekyung felt it was easier to bring it himself.

Today’s surgery was completely Taekyung’s solo performance.

‘That elevator (retractor: a device for lifting structures such as organs or blood vessels)……’

Taekyung suddenly stopped talking and fell into thought.