Fifth Vital [EN]: Chapter 95

Fifth Vital- Episode 95 (95/502)

Episode 95. A Hole, You Say?

Tae-kyung pressed down on the patient’s abdomen with gentle force, releasing gas while slightly turning his head to the side.

“Lee Chan-hee! Report again.”

“Patient’s blood pressure is rising again. Oxygen saturation is also recovering.”

The nurse quickly reported the numbers.

“I have the ephedrine [a medication used to raise blood pressure] you mentioned ready. Should I administer it?”

Another nurse brought the medication Lee Chan-hee had reported and asked.

“No, it’s okay.”

“Doctor, what’s going on?”

Lee Chan-hee, bewildered by the series of events, asked.

Normally, he would have mechanically reported immediately upon hearing the order, but he was so out of it that he forgot to report and asked the question first.

“What else could it be?”

Tae-kyung, as if understanding his junior’s feelings, replied in a warmer tone than usual.

“It’s stomach perforation because it hurts during the endoscopy.”

“The patient’s WBC [white blood cell count] and CRP [C-reactive protein, an inflammation marker] levels didn’t rise significantly.”

“He’s elderly. In the elderly, overall immune function often fails to keep up with infections or inflammation.”

“Ah….”

“That’s why you shouldn’t rely too much on test results in the elderly. This patient kept complaining of pain and was still in pain even after being given narcotics.”

Come to think of it, the patient continued to experience pain even after being administered narcotic painkillers.

“Then you should suspect perforation rather than relying on the numbers.”

“But the abdominal rigidity wasn’t pronounced.”

“Ah, this?”

In response to Lee Chan-hee’s question, Tae-kyung pressed down on the patient’s abdomen, and it sank in to some extent.

“That’s fat. Fat naturally goes in easily. You have to look at the rigidity of the muscles. If you’re not used to it, you can misunderstand. You might mistake the fat being pressed as the abdominal muscles being pressed, and misunderstand that peritonitis [inflammation of the abdominal lining] isn’t severe yet. You have to press the patient a lot to know.”

“Doctor, then how did the patient’s blood pressure rise again just now?”

“Just a moment. Let me explain to the guardian first.”

Clack-

“You must have been very surprised, right? I’m Kim Tae-kyung, the person in charge here.”

“Yes….”

The guardian still looked bewildered and hadn’t regained her senses.

“The patient’s condition was so urgent that I performed the emergency procedure before explaining. Currently, the reason is unknown, but it seems that a perforation occurred in the digestive system due to the endoscopy.”

“If it’s a perforation, does that mean a hole?”

“Yes, it seems like a hole has formed.”

“A, a hole? Oh my goodness! How could this happen….”

“When it’s in the upper organs, like the stomach or esophagus, air escapes there because you keep breathing. Then your stomach becomes bloated like this.”

“Yes, it was more bloated than usual.”

“The problem is that the pressure can press on the blood vessels returning to the heart or press on the heart itself.”

“The heart?”

“Yes. This can lower blood pressure and become dangerous. In fact, such cases are rare, but your patient was in that condition. So I released the air and lowered the pressure. Currently, this emergency measure has been taken. We will prepare quickly and perform surgery.”

“Ah, yes. Thank you, doctor. Thank you so much.”

“Mi-kyung….”

“Mom! Are you okay? I was so scared thinking something would happen to you.”

“I feel like I can live now.”

As the patient, who was losing consciousness, began to speak, the guardian, who had been expressing gratitude, grabbed her mother’s hand and shed tears.

“Dr. Lee, just a moment.”

“Yes, Doctor.”

Tae-kyung called Lee Chan-hee out of the bedside.

“In fact, such cases are not common. I was able to provide appropriate emergency treatment because I have experience. In the future, when such patients come, rather than relying on test results or images, use them as a reference to make judgments based on your knowledge, theory, and experience. And do it quickly. Got it?”

“Yes, Doctor. I’m really sorry.”

“There’s no need to be sorry to me. Have a sorry heart for the patient and take good care of that patient. First, call Dr. Jung and prepare for emergency surgery. Can you go in?”

“Yes, of course. I’ll go in.”

* * *

-How did it go? Hey? Are you still at the hospital?

“You were right.”

The internal medicine doctor, who had been watching the whole situation in the emergency room, went outside the hospital for a moment and was on the phone with an acquaintance.

“I’m talking about the director here.”

-You mean Kim Tae-kyung?

“Yeah, that guy. That doctor is different. That old man was in a dangerous situation, but that director treated him quickly.”

The internal medicine doctor, who had been anxious that the patient might be in danger, was also in a much lighter mood.

-I heard he used to dominate Shinhwa University Hospital. I don’t know why he’s at such a remote hospital now, but he’s definitely an amazing person.

“That’s what I’m saying. I got through a crisis because of you. It looks like the patient will be going into surgery soon.”

-Did you talk to the guardian?

“Don’t even mention it. The guardian is so out of it that I couldn’t even bring it up. I’ll have to talk to her after the surgery.”

-Still, just in case, hire a lawyer and don’t say anything disadvantageous when talking to the guardian.

“Okay. I already contacted the lawyer you told me about.”

-So, try not to accept too many elderly patients. That’s why I don’t accept them. Make up an excuse and refuse.

“I should do that from now on. What kind of doctor is he… I really aged ten years.”

Even at this moment, unlike the guardian who was full of worries about her mother who was about to undergo surgery, the internal medicine doctor, who was the cause of this incident, seemed to care more about himself.

* * *

“Anesthesia is complete, Doctor.”

“Thank you, Dr. Jung.”

“You’re welcome. But it seems like Dr. Lee is very surprised.”

Ui-jin said, looking at Lee Chan-hee, who was unusually silent.

“Dr. Lee, are you okay?”

“Yes, Doctor. I’m okay.”

“You don’t look okay at all.”

Sometimes people freeze when they are too surprised. Lee Chan-hee was like that.

Reality is often different from theory. This was the case now.

Until now, he thought he had handled patients to some extent, but when faced with a situation he had never experienced, he couldn’t do anything.

He was honestly afraid that the patient he was in charge of might be in trouble, and his surprised heart did not calm down easily.

The surprise and shock had not yet subsided, and it was enough to cover up the fear he felt in the operating room.

‘I’m sorry, patient.’

Lee Chan-hee was just feeling sorry for the patient who was lying anesthetized on the operating room bed.

“Sunbae [senior]! Please save our baby.”

Ui-jin, who made eye contact with Tae-kyung, sent a sign with her lips and eyes to comfort Lee Chan-hee.

“Lee Chan-hee?”

Tae-kyung called Lee Chan-hee, who was standing opposite him with the surgical drape covering the patient, after completing all the sterilization.

“Yes, Doctor.”

“Give me two 10mm trocars [surgical instruments used to create an opening in the body] and one 5mm trocar. You were very surprised earlier.”

Tae-kyung continued the conversation while performing the surgery.

“I thought it was really fortunate that you came at that time, Doctor. It almost became a big deal.”

“Such cases are rare, but think of it as a valuable experience. Once you experience something like this, you’ll never forget it. It’s probably properly imprinted in your brain today. Scalpel and mosquito, please.”

Tae-kyung dug into the fat inside the abdomen with the end of the mosquito [a type of surgical clamp], grabbed the fascia [a layer of connective tissue] at the end, and lifted it up.

Now that the two’s teamwork was so familiar, Lee Chan-hee grabbed the fascia greatly with Kelly [another type of surgical clamp] even without Tae-kyung having to say anything. Then he took the trocar and pushed it into the patient’s abdomen.

“Okay, make two more holes here, do 10mm on this side and 5mm on that side.”

“Yes, Doctor.”

Lee Chan-hee did as ordered and pushed the camera below the navel.

“Oh my, I can see it right away as soon as I go in. It must have hurt a lot.”

Tae-kyung could immediately tell how much pain the patient felt when he saw the inside with the camera.

“Give me the suture.”

He puts the instrument for suturing back into the abdomen for a long time.

Other instruments used to move or fix organs all have a handle like a gun and a long front of about 50cm. But the instrument for suturing has a handle like a sword.

This is because you can give full force when suturing tissue.

If it was a short handle like a pistol, it would put strain on your wrist while twisting it, and you wouldn’t be able to give full force.

Most surgical tools are designed and manufactured considering these surgical situations.

“Bite the needle and give it to me.”

“It’s vicryl [a type of absorbable suture].”

It is difficult to suture outside the body, which is the tip of the hand in front of you. The strength of the force when suturing and the boundary between the tissues being sutured must be well matched.

It’s not a matter of knowledge, but a part that you can only do completely after you get used to it through repetition.

It is by no means easy to grab an instrument in the shape of a sword and suture tissue more than 50cm away, relying only on the camera.

Of course, it’s much easier to open the abdomen.

“Lee Chan-hee?”

“Yes, Doctor.”

“If you think you can suture well by opening the abdomen, including patients like this in the future, then don’t hesitate to open it.”

“Yes?”

“It’s best to do it well with laparoscopy [minimally invasive surgery] like now, but that’s only when there’s a premise that you can suture that fundamental hole well.”

“Yes, I understand what you mean.”

“It’s not easy if you’re not used to it. The stomach has so much tension that you have to completely block the entrance with suture thread, but if you can’t maintain the force in the process of tying the knot, it will come loose right away, and the wall of the stomach is thick again. So like this….”

Tae-kyung penetrated the wall of the stomach deeply and widely with all his might. And he pulls the needle out over the other side of the stomach, leaving a hole in the middle.

Here, he ties the knot quickly and accurately two or three times so that the force is not lost.

“Okay, let’s go in a little more with the camera.”

Repeat the previous process once more before the suture comes loose again.

“You can repeat this a few more times. In fact, the aftermath is more of a problem.”

“I’ll wipe the camera once.”

After that, Tae-kyung sutured the perforated area three more times. Proceeding carefully and cautiously.

“Okay, let’s look down.”

“Down there?”

“Yeah. The gastric acid and food that were on top have all spilled down. We have to wipe it once. Is the normal saline [sterile salt water solution] connected?”

“Yes, it’s connected.”

Swoosh-

When Tae-kyung put the instrument on the palm of his hand and pressed the button, a thick stream of water came out.

“Is this a little cold? Please change it to a warm one. I’m going to do a lot and take a lot out.”

While the normal saline was being replaced with warm saline, Tae-kyung looked closely at the small intestine visible through the camera.

“Fortunately, the inflammation in the small intestine is not severe. You must always check the degree of inflammation and the presence or absence of perforation by looking at the small intestine like this before finishing the surgery. Got it? Keep that in mind.”

“Yes, Doctor. I will keep that in mind.”

“It’s been replaced.”

“Okay. Irrigation [flushing with fluid].”

After that, remove the trocar and close the abdominal wall completely.

“Chan-hee. I’ll write the surgical record and meet the guardian. See if they’re in front.”

“Yes, Doctor.”

“Okay! Let’s finish up.”

* * *

“Guardian of Go Chun-rye?”

“Doctor!”

As soon as Lee Chan-hee called the patient’s name, the internal medicine doctor from earlier rushed out as if he had popped out of nowhere.

“Doctor. The patient had severe ulcers in the perforated area, right? The patient originally had a severe underlying disease, right?”

Lee Chan-hee stared blankly at the internal medicine doctor who rushed in with eyes like a hyena aiming for prey.

“Oh! Are you the guardian? You’re different from the person I saw earlier?”

Tae-kyung, who had approached in the meantime, looked at the internal medicine doctor and asked.

“Doctor, he’s not the guardian, he’s the director of the OO Hospital who performed the endoscopy.”

“You’re Director Kim Tae-kyung, right?”

As soon as the internal medicine doctor saw Tae-kyung, he greeted him as if he had seen an old colleague and asked a question that was favorable to him.

“You’re the director of this hospital, right? You also performed the surgery yourself?”

“Yes?”

“Go Chun-rye had severe ulcers, right? It was originally severe, right? Right?”

“Ha!”

A wry smile flowed from Tae-kyung’s mouth, narrowing his brows.

“Older patients….”

Tae-kyung, who didn’t want to hear any more nonsense, cut off the internal medicine doctor’s words.

“Yes?”

And he threw a sharp shout at the shameless face.

“What are you doing right now!!”