Chapter 202
Episode 202 Qualification to Hold a Blade (2)
As the IV fluid was infused at a rapid rate, the blood pressure began to rise slightly.
But we need the blood to get here…
“The blood is here! It’s been released!”
A nurse wearing blood-stained gloves ran into the Resusc holding an icebox laden with red blood packs.
It came right away.
I immediately connected the blood transfusion set to the thick central venous catheter port that Lee Minjae had just secured. And the moment I hooked that line up to the Level 1 Rapid Infuser, which had been pre-warmed…
The pressure skyrocketed along with a humming mechanical sound.
With the gravity-drop method of a standard IV fluid set, at most dozens of cc enter per minute. But this machine was different.
[Temp: 39.0°C]
[Pressure: 300 mmHg]
It instantly warmed the cold, refrigerated blood to 39 degrees—slightly higher than body temperature—to prevent hypothermia, and it filled the blood vessels with blood at a brutal pressure of 300 mmHg. It literally meant it was the equivalent of plugging a high-pressure hose into a blood vessel.
Sluuuurp—
The bright red blood was violently sucked in through the tube.
“Let’s check the vitals.”
Lee Minjae's and my eyes fixed on the monitor at the same time. Sweat trickled down between my furrowed brows.
Please, please rise.
Ding—
[BP 72/45]
Ding—
[BP 75/48]
Ding—
[BP 80/52]
The graph, which had broken through the floor and plummeted into the basement, finally stopped its descent and began to climb.
“Okay,” Lee Minjae shouted, letting out a sigh of relief. “For now, let's set the target between BP 80 and 90. If we raise it too much, the area where the bleeding stopped will burst again, so we'll maintain permissive hypotension.”
“Yes, sir! Maintaining systolic at 80!”
“Yessir!”
The nurses repeated the order and finely adjusted the speed of the infuser.
Right now, the goal wasn't to achieve a normal blood pressure of 120. We had to perform a tightrope walk to prevent further bleeding while maintaining the absolute minimum perfusion to the brain and heart.
“…All 4 packs are here!”
Meanwhile, the numbers on the monitor were regaining a more stable color.
BP is 85.
The systolic blood pressure settled in the mid-80s.
The pulse is 110.
The heart rate, which had soared crazily up to 145 beats per minute as a compensatory mechanism triggered by shock, was also stabilizing and decreasing again as the blood was replenished.
It was then.
“Ugh…”
A groaning sound leaked out from the mouth of the limp patient. I pulled out my penlight and checked the patient's eyes.
“Pupillary response is back.”
When I touched the patient, his face contorted.
“Gah…”
The weak pain response, which had been lost, also returned. It was the clearest evidence that blood flow to the brain had started circulating again.
Thank goodness. I can breathe a sigh of relief.
I wiped the sweat from my forehead and turned around. My eyes met those of Kim Seo-ah, a 1st-year resident, who was still standing there with a solemn expression, holding a thoracic incision set in both hands.
“…”
“…”
I signaled with a glance for her to put it away immediately. Interpreting my gaze as, 'Regrettably, you're postponing the chance for surgery until next time,' Kim Seo-ah stealthily hid the set behind the cart.
It was just at that timing.
Rattle—!
The heavy door of the Resusc opened roughly. Two men wearing gowns over dark green scrubs walked in.
Hwang Seung-woo, the fellow on duty for Trauma Center Thoracic Surgery. And Professor Jeon Tae-jung, an associate professor of trauma surgery and one of the power players at the center.
Walking in with long strides, Professor Jeon Tae-jung scanned the patient and asked briefly, “What's the situation?”
“Upon the patient's arrival, a FAST exam was performed immediately, confirming fluid retention around the spleen, and a chest X-ray showed findings of a massive left hemothorax, so a 28-Fr chest tube was inserted.” I pointed to the drainage container. “After insertion, 1,500 cc drained, so it was judged to be massive. Immediately after drainage, the BP dropped to the 70s and shock ensued, but after securing a central venous line, 4 packs of pRBCs and 4 packs of FFPs were rapidly administered using a rapid infuser. Now, the vitals are stabilized with a BP in the 80s and a pulse of 110. Consciousness has also recovered to a lethargic state.”
Professor Jeon Tae-jung nodded, checking the dark red blood pooled in the drainage container and the numbers on the monitor. “It's definitely torn. Whether an intercostal artery went out or the lung tore.”
Then, his gaze suddenly drifted toward the back of the cart that Kim Seo-ah hadn't managed to hide completely. A gleaming scalpel set. Professor Jeon Tae-jung's eyebrows twitched.
“…What is that set?”
Cold sweat trickled down my spine. How should I explain that? I couldn't exactly say, 'Our 1st-year brought it because she wanted to see me split a heart open.'
Covering the front of Kim Seo-ah slightly with a nonchalant expression, I replied, “It was just prepared in case of a potential arrest.”
“Hm.”
Professor Jeon Tae-jung looked at me suspiciously, but focusing on the patient again as if that wasn't important right now, he said, “Even if there was perisplenic bleeding on the FAST, it seems the hemothorax side is a bit larger. Both the abdomen and chest are problems…”
Hwang Seung-woo, the thoracic surgeon next to him, chimed in. “If it's 1,500 cc, we have to open the chest first. If we delay any further, shock will hit.”
“I agree. As for the abdomen, we'll open it together after opening the chest and seeing how things go.” Professor Jeon Tae-jung made the decision. “Okay, let's take him up to the OR right away.”
“Yes! I've had Emergency Operating Room 2 set up.”
…
…
“The oxygen tank has been swapped out, and preparation for transfer is all done!”
“Moving him. One, two, three!”
“Heave-ho!”
Four medical staff members threw themselves into pushing the patient's bed.
Clack.
With the sound of rolling wheels, the patient and the trauma team medical staff began to drain out like the ebbing tide.
Rattlerattlerattle.
With the sound of the receding bed wheels, only silence remained in the Resusc. On the floor, all sorts of miscellaneous packaging torn off in a hurry lay scattered. I threw off the vinyl gown that was a mess from splattered blood, ripped off the bloody gloves, and shoved them into the medical waste bin.
Rustle—
Thud—
The sound of the trash can lid closing echoed exceptionally loudly. And then, I called out to Kim Seo-ah, the 1st-year standing in the corner of the Resusc.
“Seo-ah.”
“Ye-yes!”
“Follow me.”
I jerked my chin toward the guardian consultation room. I needed to get a handle on her beforehand.
…
* * *
…
Inside the consultation room. Kim Seo-ah, the 1st-year, and I sat facing each other.
“When you palpated the femoral artery pulse, did it beat or not?”
“It beat.”
“It beat, right? In that state, we poured in fluids and blood.” I took a step closer. “Was it an indication for an emergency thoracotomy?”
“No, it wasn't.” Kim Seo-ah's voice crawled inward.
“What are the indications for an emergency thoracotomy?”
“For... for penetrating trauma patients who suffer cardiac arrest within 5 to 10 minutes before or after arrival at the hospital, or in the case of blunt trauma, when cardiac arrest occurs before or after arrival at the hospital but there is a response to CPR…” Kim Seo-ah stammered out the contents she had memorized by heart. “And for patients with severe thoracic injury whose vitals are unstable, where the systolic blood pressure continuously drops below 70 without responding to fluid therapy and blood transfusion…”
“You have it memorized well,” I cut her off coldly. “Then did that patient apply?”
“…”
“Speak. Did he apply?”
“…Th-that, response to fluid therapy…”
“He did. We did a full drop, gave blood with the rapid infuser, and his blood pressure came up. His consciousness returned too. Even if he was a transient responder, his vitals were being stabilized. Am I wrong?” A hollow laugh escaped me. “But why bring a scalpel there? Even if we assume you brought it to prepare for an arrest, what's with asking if you should slice him open in that situation? What do you think would have happened if my judgment had blurred and I opened his chest?”
We could have caused a table death by slicing open a perfectly fine chest of a patient who could be saved, worsening the infection and bleeding.
“…”
Kim Seo-ah bit her lip hard. A wave of frustration rushed in.
Because I performed REBOA, performed laparotomies, and pulled off all sorts of crazy stunts thanks to the possession and the guidance of the phantoms, it seemed that to the eyes of a 1st-year resident, it looked like some kind of a master key. A dangerous illusion that everything is solved as long as you hold a blade.
“Then why on earth?” I asked because I was genuinely curious. “Why did you do that when you knew? What is the reason you brought the set even before an order was given?”
“That… uh, you know the rumors going around about Teacher Han,” Kim Seo-ah answered hesitantly.
“What rumors?”
“Th-that, the rumor that you saved a patient by performing a quadrant packing and a laparotomy in the emergency room…”
Those damn rumors. Those dangerous stories packaged like heroic tales.
“Th-the situation was different from a typical hemothorax situation, so I was quite flustered in my haste, and I heard that Teacher Han does not hesitate to take the blade. So I thought you would open him up…”
“Ha…” I let out a deep sigh and swept my hair back. “So that's why you did it?” My voice grew louder. “You shouldn't be like that in a hospital. You're a doctor. You should move based on evidence, not based on rumors. Are you a shaman? Are you trying to kill a patient?”
“…I'm sorry.” Kim Seo-ah's shoulders slumped completely.
There was no point in scolding her further. She must have realized her mistake too.
“Fine. Get out. Go run the set through sterilization again, organize today's case, and submit it for next week's weekly conference. You should consider yourself truly lucky to have been caught by me.”
“Yes… I understand.”
Click.
Kim Seo-ah escaped the consultation room as if fleeing.
Thud.
When the door closed, I was left alone in the narrow consultation room.
“Haaaaa…”
The strength left my legs, and I collapsed straight onto the chair. Burying my body against the backrest like that, I looked up at the ceiling.
What did I do?
Complex emotions weighed heavily on my chest. I saved people because I wanted to save them. In my own way, I did my best, mobilizing all the skills I possessed to rescue patients.
Did I go too far?
Were my eccentricities, my successful gambles, giving the wrong signal to my juniors? The dangerous illusion that it's fine as long as the result is good even if you break principles, and that holding a blade is cool.
In an instant, the frosty gaze and words of Professor Cho Kyung-woon of Thoracic Surgery, whom I had run into in the conference room earlier, brushed past my mind.
[There's a paper-thin difference between being commendably courageous and being reckless.]
[Because when caught in the hands of an clumsy butcher, it's more dangerous than any weapon.]
Was he worried about this kind of thing?
The reason he clicked his tongue looking at me. The reason he was displeased with me making a fuss. Was he worried that I would become like the Kim Seo-ah just now, or that I would mass-produce monsters like the Kim Seo-ah just now?
It was an indication, I argued internally. The cases where I took the blade were clear indications, when the arrival of the surgical on-duty doctor was late or the patient was right on the verge of dying… though.
It was hindsight bias. To others, it could just look like a reckless show performed by a 3rd-year resident. And it was a matter of course that a fledgling resident who admired that show could hastily take up a blade and cause an accident.
It's heavy.
The title of a genius. And the nickname of a butcher. It wasn't a matter of simply gathering LP, using skills, and feeling good about it. Every single one of my actions was changing the standards of my juniors. That weight pressed down on my shoulders.
It was then.
Creak—
The door to the consultation room opened cautiously. Turning my head, Kim Seo-ah, who had just been scolded and left, poked her face through the crack of the door hesitantly.
“Uh… Han Saem.”
“What is it?” I replied with a tired voice.
Just as I was about to furrow my brows, thinking she had made another mistake—
“Ah, that, I'm really sorry but… among the patients who just arrived…” Kim Seo-ah gulped. “There's a patient that I think Han Saem needs to see.”
“…Huh?”
I raised my body in puzzlement. A patient she thinks I need to see?
“They're looking for Han Saem.”
A patient looking for me?