Chapter 207

Episode 207 Thoracic Surgery (4)

‘But I just called them a moment ago. When at all did this professor gentleman arrive…?’

I felt a chill run down my spine and glanced behind Professor Jo Gyeongun.

It had definitely been less than five minutes since Jeong Jaesang hung up the phone. Unless he had learned how to teleport, he must have arrived early and been nearby before running over. Talk about impeccable timing.

“Ah, Section Chief!”

The moment Jeong Jaesang spotted Professor Jo Gyeongun, he darted out from behind. He looked like a herbivore instinctively fleeing the moment it laid eyes on a tiger.

“Earlier…”

“What is this? Explain.”

Professor Jo Gyeongun’s low voice filled the space. Even though he didn't shout, the air itself seemed to vibrate. Pale with fear, Jeong Jaesang stammered.

“The patient's vitals broke and CVP climbed up to 22, so I strongly suspected tamponade… But there was no fluid on the echo… The screen kept tearing… So I, I wondered if it was an air embolism or a machine error…”

“And so?”

Jo Gyeongun’s gaze shifted toward me. To be exact, it landed on the syringe full of air in my hand and the betadine stains soaked heavily across the patient's chest.

“Why is a resident dispatched from another department poking a hole in the chest of our department's patient in the ICU? Huh? Is your hand just an ornament? What were you doing?”

“That…”

Jeong Jaesang smacked his lips, but he had no words to excuse himself. After all, I had stepped in while he was frozen in a daze.

If things kept going like this, only the 2nd year would take the fall. And hiding cowardly behind someone's back wasn't my style. Putting down the syringe on the tray, I stepped forward.

“It was entirely my judgment, and it is my responsibility.”

Time to turn on the silver tongue. I struggled to maintain a tone that was as calm and concise as possible. If you show fear, you lose.

Professor Jo Gyeongun knit his brows and glared at me.

“You… What is this? Having been dumped with betadine straight onto the patient's chest? Without even draping?”

“Yes, I poured it,” I admitted immediately. “Vitals were dropping below a systolic of 50, placing the patient on the brink of arrest. There was not even a minute of leeway to cover them with sterile drapes and disinfect. I apologize for breaking the fundamental principles of sterilization and failing to focus on aseptic technique.”

First, admit the mistake. However, make the justification absolutely clear.

“On the echo, I noticed the image disappeared only during systole, and I suspected cardiac tamponade caused by Tension Pneumopericardium. Accordingly, I immediately performed decompressive puncture using a syringe with an 18-gauge needle. After confirming the discharge of air, the vitals have now returned to 100 over 60, with a pulse of 100.”

Problem solved. Patient survived. The result justifies the process. I attempted a frontal breakthrough using that exact logic.

However, Professor Jo Gyeongun’s expression did not soften.

“No, well. Saving a life is a good thing. I also understand that it was an urgent situation. Even so, for you to… Sigh. This is a fundamental principle.”

To a strict disciplinarian like him, the mere fact that a resident from another department dared to perform a procedure in the ICU—the sacred sanctuary of Thoracic Surgery—without the attending doctor's permission, and while utterly disregarding sterilization, seemed unacceptable. His face began to turn red with anger.

“If you had at least said you'd do better next time, I wouldn't say anything, but…”

Just then, a voice cut in.

“Oh, Section Chief. Calm down, calm down. The kids only did that because the situation was so urgent.”

Someone suddenly appeared from behind the boiling Jo Gyeongun and wrapped an arm around his shoulder. It was a doctor with a young impression.

Professor Jo Gyeongun turned his head sharply and frowned.

“You…!”

“Section Chief, if you shout here right now, you'll wake up all the patients. For now, the vitals are back. I'll organize everything related to this matter myself, so you head up first to get ready. I'll clean up the situation here and follow you right away.”

Like a skillful old fox, he very naturally pushed Professor Jo Gyeongun outside the door. Though still huffing, Professor Jo Gyeongun oddly seemed to lose his steam at the man’s words.

“Ha… Professor Han. Just how are you training them…”

“It's because it hasn't been long since I got here. I'll educate them separately. Go on, quickly, go. The kids are getting intimidated for no reason.”

“Ugh…”

Unable to find words to reply, Jo Gyeongun shot one last glare at Jeong Jaesang before walking straight out of the surgical ICU.

Rumble.

Thud.

The storm had passed.

“Whew… That was a close call.”

The man let out a sigh of relief and ran a hand through his hair.

“Once the Section Chief loses his temper, even I have a hard time stopping him, a hard time. Anyway, people just get more stubborn as they age.”

Grumbling, he walked over toward the station and picked up the chart. Then, looking back and forth between me and Jeong Jaesang, he offered a bright smile.

“Hello, Teacher.”

I quietly bowed my head. The embroidered marking stamped on his gown caught my eye:

[Cardiovascular & Thoracic Surgery, Professor Han Ihyeon]

‘Ah. It's Professor Han.’

The database in my memory brought up the search result. A young professor who was highly active, moving between the main hospital's trauma center and thoracic surgery. Because he was a thoracic surgeon dedicated to trauma, his was a face I ran into quite often near the emergency room's trauma resuscitation room. I hadn't recognized him since he was always fully set up with a mask and a cap. So it was that gentleman.

“Ah, yes, yes. Nice to meet you. It's our first time meeting formally, right? I'm Han Ihyeon, and I'm in charge of the trauma section here, while also handling the lung and esophagus surgery section for regular operations. Hyeonjae, you must have seen me often, right? In the ER.”

“Ah, yes! Professor. I've seen you a few times when handing over trauma patients.”

Professor Han Ihyeon gave a warm, genial smile and tapped my shoulder.

“Right. So you're that famous Han Hyeonjae.”

Famous? My ears perked up.

‘Is my name already spread that widely among the professors? Is it because of the DADA2 diagnosis? Or the quadrant packing?’

While secretly filled with anticipation, I asked with outward humility.

“Ah, yes. But how do you know my name…”

“Oh, it's not that I knew you from before.” Closing the chart, Professor Han Ihyeon replied with absolute bluntness. “The training department sent a mail with the list of dispatched residents, so I saw it and found out. Because it had ‘Han Hyeonjae’ written on it.”

…

“Ah, yes.”

I shut my mouth out of sheer awkwardness.

‘I almost made a fool of myself counting my chickens before they hatched.’

I had nearly swallowed a massive bowl of self-delusion. Right, there was no way a professor would memorize every single resident's name.

Whether he noticed my inner thoughts or not, Professor Han Ihyeon checked the patient's monitor and began issuing orders.

“For now, the tamponade from the pneumopericardium is resolved. We'll need to insert a tube for this. Jaesang.”

“Yes! Professor!”

“Bring a pigtail catheter. And Teacher Hyeonjae.”

“Yes.”

“You inserted the needle well. The position selection was good. But next time, let's at least drape before piercing, okay? The Section Chief might grab the back of his neck and collapse.”

“I will keep that in mind.”

“Good. Let's organize things for now, and I'll introduce myself again later during the conference, so keep that in mind.”

Professor Han Ihyeon gave a cool wave of his hand and directed the patient's treatment. I let out a sigh of relief and began cleaning up the messy tray.

As soon as Jeong Jaesang came running back in a flurry, Professor Han Ihyeon took the pigtail catheter set with skillful hand movements.

“Jaesang. Grab the guide wire.”

“Yes! Grabbed it.”

“I'll advance it, so you maintain the tension so the wire doesn't slip out. Don't lose it.”

“Yes sir!”

Professor Han Ihyeon slid a thin guide wire through the needle hole I had poked. The so-called Seldinger technique. Riding the wire, the smooth catheter pierced the skin, passed the fascia, and slid right into the pericardium.

Slip.

The tip of the catheter coiled up inside the pericardial sac, finding its seat. A conduit designed to roll up like a pig's tail so that the sharp tip wouldn't pierce the heart.

“Connect the drainage bag and fix it.”

“Yes, Professor.”

Letting out a sigh of relief, Jeong Jaesang took the suture with his sweat-slicked hands and tightly stitched the conduit to the skin to fix it in place.

Stripping off his gloves, Professor Han Ihyeon turned back to me.

“So, Teacher Han Hyeonjae?”

“Yes, Professor.” I straightened my posture.

“We've put out the immediate fire for now. We removed the air and struck a conduit in. Then, what should we do after this? Can we just leave this patient like this?”

Glanicng at the patient's ventilator, I answered.

“I think we need to extubate.”

“The reason?”

“Right now, the cause of the pneumopericardium is air leakage from the lung surgery site. If we maintain PPV (Positive Pressure Ventilation), the pressure inside the thoracic cavity will rise, and air will continuously be flooded into the pericardial space. Even though I lowered the PEEP to 1 earlier because it was urgent… as long as they are on a ventilator, positive pressure is unavoidable. I think it could be dangerous right now.”

No matter how well the pigtail was placed, if the volume of incoming air became greater than the amount being drained, the heart would be compressed again. The fundamental cause—the pressure—had to be removed.

Professor Han Ihyeon continued his questioning.

“Then, once we extubate and spontaneous breathing returns, what's next?”

“As for oxygen, we'll probably have to minimize positive pressure by using an Ambu bag or a mask… Ultimately, we have to open the operating room again.”

“Open it to do what?”

“To prevent air from getting trapped in the pericardium, shouldn't we poke a hole entirely? We need to create a window in the pericardium so the air can escape into the thoracic cavity to clear the path and prevent recurrence.”

“Hmm… True, that's right. As expected, you're as smart as the rumors say. My thoughts exactly. Let's book one as an emergency.”

Professor Han Ihyeon made a decision immediately. Walking with strides, he approached the head nurse who was sitting at the station organizing charts.

“Head Nurse.”

“Yes, Professor.”

“Who is on duty for anesthesia today? I think we need to open an operating room right now.”

Checking the duty roster on the monitor, the head nurse replied.

“Ah, today it's 4th-year Teacher Lee Jinhyeon and…”

“No, not the resident. The professor. Which professor is out?”

“Ah, Professor Son Myeongjin.”

“Oh, really?”

Professor Han Ihyeon’s expression turned oddly bright.

“Then contact them and ask to quickly set up an OP. Tell them we're going in to make a window for the patient in Bed 8.”

At that, the nurse hesitated with a troubled expression.

“But…”

“Why?”

“Well, Professor Son Myeongjin… there's a rumor that he tends to avoid emergency surgeries. They said he was quite sensitive when receiving a call at dawn yesterday too…”

Anesthesia Professor Son Myeongjin. He possessed excellent skills, but he prioritized work-life balance and was notoriously infamous for utterly hating unannounced emergency surgeries.

However, Han Ihyeon snorted.

“Oh, that's just his way of complaining, complaining.”

“Pardon?”

“He says that, but in the end, he enters every case. Though he grumbles, who puts the patients under anesthesia best once they push them into the room? Every single time an emergency blows up in our hospital, only Myeongjin goes in, so what do you mean?”

Waving his hand, Professor Han Ihyeon spoke with a voice full of confidence.

“Anyway, just call him. If you say I booked it, he'll come without a single word.”

The head nurse still looked uneasy, but she couldn't reject the professor's order. She picked up the handset.

“Ah, yes. I will contact him.”

With that, Han Ihyeon turned his head toward me.

“Teacher Han Hyeonjae?”

“Yes.”

“Teacher Hyeonjae should observe too, right?”