Chapter 205

Episode 205 Thoracic Surgery (2)

“What time is it now?”

Jeong Jaesang asked in a groggy voice.

His eyes were half-closed, and his focus was fixed somewhere on the void over my shoulder.

I raised my left wrist to check the time.

“Uh… It’s 6:03 AM.”

At that moment, something resembling alertness appeared in Jeong Jaesang’s zombie-like eyes.

“Ah, that… Uh, wait a moment. Please wait just one minute.”

Hurriedly, he threw open a worn-out steel closet in one corner of the Doctor's office. He threw off his crumpled, stained gown and pulled out a fresh, snow-white gown to put on.

After tidying his clothes in that sloppy manner, he wiped his dry face with his hands once and looked at me.

“Yes. For now, uh… I received the role to guide you, Teacher Han Hyeonjae.”

“Yes.”

“Professor Jo told me to have you tag along and observe for now… Let’s go.”

“Right, right.”

To suddenly tell me to follow him out of nowhere.

What kind of situation is this?

However, when in Rome, do as the Romans do, as they say.

Since I had dropped into the unknown world of Thoracic Surgery for now, I had no choice but to follow the guide’s words.

I followed behind him without a word of complaint.

Jeong Jaesang stepped out of the Doctor's office door, passed through the long ward Hallway, and headed toward the place where the Elevator was located.

“Where are we going now, then?”

Jeong Jaesang replied while pressing the Elevator Button.

“The 5th floor. After going down to the 5th floor of the East Wing, we take the connecting passage to go to the Intensive Care Unit on the 5th floor of the Main Building. Our department’s ICU is located there.”

“The Main Building.”

Since I am usually based only in the Emergency Medical Center Building, I rarely have any reason to go there.

“Do you usually go like this every morning?”

At my question, Jeong Jaesang nodded his head while rubbing his hollow Face reflected in the Elevator mirror.

“Yes… For now, around 6 o'clock, we round the ICU to check for any unusual matters during the night. After that, we go up to the ward and do a clean sweep of the ward patients once.”

He sniffled his Nose.

“Yes. After rounding like that, we have the morning Conference in the meeting room at 7 o'clock, and from 8 o'clock, we do a full round with the professors. Once that is finished, we enter regular Surgery.”

“….”

A schedule that takes one's breath away.

They do that every day?

“I see….”

It was not for nothing that the Thoracic Surgery residents were an endangered species.

Ding-dong—

With a cheerful chime, the Elevator doors opened.

[5th Floor.]

“Let’s go for now.”

“Ah, yes.”

We crossed the long skybridge connecting the East Wing and the Main Building.

Thud.

[5F | ICU (Surgical, Medical, Neurological, Cardiovascular)]

Reaching the 5th floor of the Main Building that way, heavy automatic doors Appeared in a row.

[Surgical Intensive Care Unit – SICU]

A place where patients requiring intensive treatment after Surgery are gathered.

Beep.

Jeong Jaesang scanned his employee ID card with familiarity.

[The door is opening.]

We cut across the SICU Hallway and headed deep into the innermost corner.

While walking, Jeong Jaesang glanced back and opened his mouth.

“Ah, but Teacher. You are a 3rd Year, so you can speak casually to me….”

Jeong Jaesang seemed quite uncomfortable with me using strict honorifics.

I waved my hand in dismissal.

“Since I am in a position of freeloading in another department I was dispatched to, it's a bit….”

“Ah, no, it’s fine. Anyway, we’ll be sticking together Throughout the 2 weeks. Your Year is higher than mine. Rather than having the lineage tangled up, it's less uncomfortable for me if you just make yourself comfortable.”

Certainly, under the hospital hierarchy, it is a bed of thorns for a 2nd Year to hear honorifics from a 3rd Year.

Besides, this fellow looked so exhausted now that he seemed to want to save even the energy required for courtesy.

“If so, I’ll speak a bit more comfortably.”

“Yes. It's more comfortable for me if you speak casually, too. Thank you. Yawn….”

Jeong Jaesang, who gave a quick bow, faced forward again.

Finally, the End of the Hallway.

[TSICU – Thoracic Surgery Intensive Care Unit]

The heart of Thoracic Surgery where critical patients among those who completed heart Surgery are hospitalized.

“This way.”

“Oh, Teacher. You’re here… Uh? Who is that person?”

The Nurse sitting at the Station monitoring the Monitor caught sight of me and opened her Eyes wide.

‘Since an unfamiliar Face suddenly appeared out of nowhere, it makes sense to be surprised….’

Jeong Jaesang replied.

“He is the person dispatched to our department. Teacher Han Hyeonjae from Emergency Medicine. He will be here for 2 weeks.”

“Ah~ That Person from the rumors! Hello, Teacher.”

The Nurse gave a meaningful smile and bowed her head.

Rumor?

What Rumor?

I smiled awkwardly and bowed my head.

“Hello.”

As soon as the greeting was finished, Jeong Jaesang snapped to attention and instantly shifted into work mode.

“Any unusual matters during the night?”

The head Nurse also immediately turned over the Chart and started reporting.

“Ah, yes. Patient Lee Hoyoung in Bed 2, who came out after Surgery at 11 o'clock last night. He was fine until 4 AM, but from 5 AM, the drainage volume increased a bit. It’s 150cc per hour, but the color is a bit red.”

“150cc? Red? It’s not serosanguineous?”

“Yes. It's not to the point of being completely bloody, but it's a bit dark. The Lab hemoglobin is maintaining at 10.2, though….”

“Alright for now. I’ll go take a look.”

Jeong Jaesang quickly rubbed his hands with hand sanitizer and Walked With strides toward Bed 2.

Before following behind him, I paused for a Moment and looked Around.

A Scenery quite different from the Emergency Room.

The sound of wind blowing from the ventilator.

The humming sound of the ECMO substituting for the heartbeat.

A place where billions of won worth of state-of-the-art life support equipment lined the room, desperately holding onto the patients’ lives.

‘It’s quite… something.’

Overwhelming.

And.

‘It’s quiet.’

In the meantime, Jeong Jaesang finished the Check.

“For now, since the bleeding volume increased… we can't just leave it alone.”

Jeong Jaesang scrutinized the Bed 2 patient’s drainage bottle at eye level and opened his mouth toward the Nurse.

“Let's look for mediastinal widening. We need to check if blood is pooling inside and pressing on the heart, so please request a portable X-ray. Tell them to come.”

“I’ll let them know.”

“Once the results are out, uh… notify me right away. Whether it's the portable Picture or the Lab results that went out earlier. Because if the hemoglobin drops, we need to prepare for a blood transfusion.”

“Yes, yes, understood.”

The Nurse nodded her head while scribbling notes.

Without even a Moment to catch his breath, Jeong Jaesang turned to the next Chart.

“Any other unusual matters?”

“You know Patient Han Youngsu in Bed 6, who received an AVR, right?”

“Ah, that person. The one who complained of palpitations since yesterday evening and showed Afib with RVR from 5 AM?”

Jeong Jaesang knew the patient's condition inside out.

So this is a department that looks after inpatients.

“Yes, yes. After giving amiodarone according to your orders, we took an EKG.”

“Let me see it.”

Jeong Jaesang took the EKG paper handed over by the head Nurse.

“…Well, nothing special? The heart rate is caught at around 90 beats.”

He let out a Sigh of relief and laid down the EKG.

“The rhythm is still Afib, but since the BP isn’t dropping and the heart rate is controlled, let's keep an eye on it for now. We need to report to the professor during the 8 o'clock rounds to make a Decision on whether to adjust the warfarin dosage or add an anticoagulant.”

“Yes, yes. Understood.”

Standing one step behind with my arms crossed, I quietly watched that Scenery.

‘Heh.’

Admiration slipped out naturally.

A 2nd Year is 1 year below me.

Even taking into account that I am a 3rd Year in the Emergency Room and that fellow is in the specialized field of Thoracic Surgery, his Judgment speed and coping ability were extraordinary.

Interpreting the EKG and adjusting the medications was as natural as breathing.

‘A 2nd Year certainly gives off the vibe of an ace, too.’

Our 2nd Years rolling around in the Emergency Room are quick on their feet as well, but here, how should I put it?

Does the weight of dealing with the heart, the frontline of life, feel like it forces a person to grow?

‘Is it because they grind people down? Did the brain awaken by survival instinct because they don't let them sleep?’

Watching Jeong Jaesang handle the work perfectly with half-closed eyes, I could not help but express my respect to the Thoracic Surgery residents.

Respect.

Jeong Jaesang closed the Chart and turned back to me.

“Sorry. Work is busy, so I couldn't even give you a proper explanation.”

“No, keep it casual. Don't mind me.”

“Anyway, Bed 7 is an OPCAB. So, it’s a person who received a coronary artery bypass graft while the heart is beating without running a cardiopulmonary bypass machine….”

“Oh.”

My eyes sparkled.

OPCAB.

Unlike general Surgery where the heart is stopped and a cardiopulmonary bypass machine is run, it is a Surgery that is only possible when the hand skills of a Thoracic Surgery surgeon reach the peak to connect microscopic blood vessels on top of a throbbing heart.

“Amazing. As expected of Thoracic Surgery.”

“Because our professors are just so good at it. This person will probably go up to the general ward within Today or Tomorrow.”

Jeong Jaesang spoke calmly and moved his steps toward the last Bed.

It was Bed 8, located in the deepest part of the ICU.

“And here, Patient Jeong Haeun in Bed 8… received Surgery yesterday afternoon, a person who underwent a right lower lobectomy.”

“Resection? Lung? Is it lung cancer?”

I tilted my head.

Since it was the Thoracic Surgery ICU, I thought most were heart patients, but a lung resection patient was mixed in.

Then again, Thoracic Surgery does not only look at hearts.

“It's not cancer. He is a person who was transferred urgently through Pulmonology due to hemoptysis. He vomited so much blood that they performed bronchial artery embolization first, but since the bleeding wouldn't stop, he eventually entered OP.”

Jeong Jaesang pulled up the patient’s Chart and continued his explanation.

“He is a patient who showed hemoptysis and, hm… a very large cavernous lesion in the right lower lobe on the CT… but there is one unusual matter.”

“What is it?”

“He said that 15 years ago in Europe, so probably France? He received emergency heart Surgery there. According to his own statement, that is.”

“Europe?”

“Yes. But they say there are no medical records from that hospital. The patient doesn't exactly remember what kind of Surgery it was either. He only remembers opening his chest and coming back from the dead. The Guardian didn't go with him back then, so they don't know either.”

A past history of heart Surgery with no records.

‘The professor must have suffered terribly….’

From a surgeon's perspective, I know it is no different from a time bomb.

Because there is no way to know how severe the adhesions inside the thoracic cavity would be, or how the anatomical structure might have changed.

“Anyway, so they said the professor who operated yesterday suffered immensely trying to dissect the adhesions. Though he came out after resecting the right lower lobe, some fluid is oozing from the surgical site and the inflammation levels are high, so we are keeping a close eye.”

‘Hm… uncomfortable.’

A reoperation in a state where the past history is unknown.

I looked at the male patient in his 50s lying on the bed.

Whether the anesthesia effects still remained, he was in a deep sleep with a ventilator attached.

The figures on the Monitor were relatively stable.

Relatively.

It was then.

Beep—

A single tone rang out from the peaceful Monitor.

“Uh?”

Beep—

Beep—

The regular heartbeat sound suddenly started to quicken.

Beep-beep, beep-beep, beep!

The tempo of the Warning sound rose sharply.

“Uh, Bed 8’s Vitals are…!”

At the Nurse’s urgent Shout, Jeong Jaesang and I simultaneously raised our heads and looked at the Monitor.

The figures that were normal just A moment ago were moving frantically.

[HR: 138 bpm]

[ABP: 52 / 41 mmHg (MAP 45)]

[SpO₂: 94 %]

[CVP: 22 mmHg]

The heart rate soared, and the Blood pressure plummeted, breaking through the Floor.

And the central venous pressure was 22 mmHg.

“…Shock?”

Jeong Jaesang’s Face turned pale.

Is it post-operative bleeding?

‘No.’

If it were bleeding, blood would be lacking, so the CVP should normally drop.

However, for the CVP to be high means….

The heart is pressed by something and cannot expand, or the pathway going out is blocked.

A patient who received lung Surgery suddenly has cardiac tamponade?

Or cardiac herniation?

Whatever the Cause, with that Blood pressure, a cardiac arrest will come soon.

“Ah, fuck.”

A Curse burst from my mouth by conditional reflex.

First day of dispatch.

6:15 AM.

I haven't even rounded with the professor once yet.

“Why are you doing this to me from the very first day.”