Chapter 211

Episode 211 Observation (3)

“Uh… yes?”

For a moment, I doubted my ears and let out a dumbfounded sound.

Get an EM board and then redo a Thoracic Surgery residency?

Did that mean doing residency twice?

And in Thoracic Surgery, of all places, which was notorious for grinding people to dust?

Professor Lee Hyeon-jae smiled past his mask, as if he had noticed my expression as my mind went blank.

However, just because his mouth was smiling didn't mean his hands were resting.

While I was losing my edge, fiercely analyzing in my mind whether this gentleman was being serious right now or just playing a joke to tease a dispatched resident, his hands were already perfectly suturing the damaged area of the torn lung.

“For now, the hole is plugged. Give me a PGA sheet.”

“Here it is.”

Without even a side glance, Han Hyeon-jae accepted the thin, transparent, absorbable mesh sheet handed over by the scrub nurse.

It was a reinforcing material applied to prevent air from leaking after lung surgery.

He quickly cut the sheet to fit the size of the defect and gently draped it over the surface of the lung.

Then, he accepted a syringe-type instrument and began to apply something over it.

“Resident Hyeonjae. Don't daze out.”

“Ah, yes!”

“Do you know what it is that I am applying on top of the sheet right now?”

Han Hyeon-jae asked, keeping his gaze fixed on the surgical field.

I carefully examined the transparent, sticky fluid being applied.

“Uh… is it a tissue adhesive like biological bond, that is to say, fibrin glue?”

The role of sealing so that the stitched area wouldn't rip open or let air leak through microscopic gaps.

“That's right. Correct.”

Professor Han Hyeon-jae nodded and picked up a pair of forceps.

Then, at one corner of the surgical field, he pinpointed a yellowish lump that he had stripped away earlier during the adhesion dissection and left on a wet gauze, bringing it right before my eyes.

“Then what do you think this is?”

“……”

Oh, shit.

My pupils shook like crazy.

An irregularly shaped tissue lump that looked slippery and had a bit of blood on it.

It looked like fat, but there were countless places for fat to be in a human body.

‘Should I take a picture with my eyes right now and show it to the gallery ghosts?’

Reflexively, I was about to pop up a window in the void to my right, but then I hesitated.

When he asked with just words what the variable was during surgery earlier, I had time to pretend I was racking my brain while looking into the void to ask the ghosts.

But right now, the situation was different.

The lead surgeon was directly holding the tissue with forceps and shaking it in front of my nose, asking what it was.

‘The professor is directly pointing at something with forceps, so it makes no sense to wait and daze out for a long time before answering.’

This was simply a case of not knowing.

Dragging out time would only buy suspicion.

I quickly gave up and bowed my head.

“That… I don't know well. It does look like fatty tissue, but….”

At my honest answer, Professor Han Hyeon-jae chuckled as he withdrew his forceps.

“I just poked at you because you got everything right from earlier. This is called Pericardial fat.”

“Pericardial fat?”

“Yeah. The fat pad attached to the outside of the heart sac.”

‘He must have stripped it off in advance during the adhesion dissection while I was playing around and talking about other things with the ghosts.’

I could only blame myself for missing the flow of the surgical process.

They said there was absolutely nothing to waste in Thoracic Surgery, and indeed, even the removed fatty tissue was kept to be used again.

“You harvested it in advance.”

“That's right.”

Holding that yellow lump of pericardial fat with his forceps, Professor Han Hyeon-jae carefully brought it over the PGA sheet of the lung where he had just applied the glue.

“Then now, what should we do with this fat?”

Another surprise question.

Bringing fat to the holed area of the lung.

To plug the hole.

Then how would it be fixed?

Obviously, it had to be stitched.

My shallow surgical common sense jumped out of my mouth.

“By performing a suture to fix….”

Flash.

Professor Han Hyeon-jae’s gaze snapped sharply above his mask.

“…is not it!”

I quickly slammed on the brakes and threw my gaze toward the blue window floating in the void.

Korean Slave 1 (Male): What do u do when u take fat and put it back on the lung? Do a suture?

Mes of the God (Male): Speak straight. You're putting what where?

Korean Slave 1 (Male): Sry sry covering the fistula area! Applied bond and covered with a sheet, but then putting fat on top of that again!

Hippocrates' Descendant: Ohho, it is fat! fat! Free fat areas are very usefully used when filling tissue defects or reinforcing suture areas, living doctor!

Thoracic Surgery Ancient Water: The grandpa is saying uselessly obvious things again. If it's sutureless, I think they'll go with a sandwich technique using adhesive.

‘Sandwich technique!’

I grabbed the lifeline thrown by the ghost.

“That… it seems like you will stack it layer by layer using a sandwich technique with a sutureless method!”

Without stitching with a needle, it was an advanced Thoracic Surgery technique that perfectly blocked air leaks by bonding layer by layer like a sandwich in the order of: lung surface - fibrin glue - PGA sheet - fibrin glue - pericardial fat.

“Yes.”

Han Hyeon-jae's dry voice was heard.

His hands had already set down the forceps and were wiping away the remaining bloodstains.

“Though while Resident Hyeonjae was making that answer, covering it and shooting the bond was all finished.”

My gaze shifted toward the patient's lung.

During that incredibly short time when I was desperately seeking the answer with the ghosts, Professor Han Hyeon-jae had already covered the PGA sheet with the pericardial fat in the perfect position and even applied the adhesive over it, completing a flawless sandwich without a single gap.

“…Heck.”

From now on, if it looked like I didn't know, I should just say I didn't know.

…

…

“I'll make a window. Metzenbaum.”

At Han Hyeon-jae's direction, the scrub nurse quickly handed over the rounded scissors.

“Metzenbaum.”

Han Hyeon-jae smoothly accepted the scissors and began to carefully trim the borders of the microscopic rupture site in the pericardium.

Snip, snip.

As the tough pericardium was cut away, a square window was created.

Inside it, the red heart muscle beating powerfully was vividly visible.

“Resident Hyeonjae.”

“Yes, Professor.”

“You're focusing, right? We handle the heart and lungs. This is what Thoracic Surgery is. Isn't it cool, I mean.”

“…Yes. I will think about it positively.”

‘Wait a minute.’

Scouting aside, a question arose.

Right now, the right thoracic cavity had a large lump empty because the right lower lobe was cut out yesterday.

But if you punch a door-sized window open in the pericardium like that?

‘What if Cardiac herniation occurs as the right ventricle, which repeatedly contracts and relaxes, rapidly pushes out into the empty space of the right thoracic cavity after forming the window?’

The heart leaving its proper place and popping out of the hole?

Or what if the vascular axis got twisted in that popped-out state?

If that happened, the vena cava would twist and cardiac output would plummet, which could trigger the worst-case variable of immediate cardiac arrest.

If a hole was made, it had to be blocked, but blocking it would defeat the purpose of the window.

‘How do they solve that? Do they cover and block it with the fat piece taken off earlier like before?’

I peeked out of the corner of my eye and brought up the blue window in the void to my right.

Korean Slave 1 (Male): A question came up. Doesn't herniation happen? The right thoracic cavity lung was cut out so it's empty. If you drill a window, the heart will pop out.

As soon as the question went up, an alarm sounded.

Mes of the God (Male): This is why newbies are Tsk tsk. That's why we dissect and pad it.

Korean Slave 1 (Male): Uh? Pad what?

Thoracic Surgery Ancient Water: A Muscle Flap or a lump of Pericardial fat! Taking strong tissue from the surroundings and stitching a net like a hammock so the heart doesn't fall out of the hole.

Operating Room Ghost 3 (Male): Mesh, which is artificial tissue, would be fine too.

Mes of the God (Male): I told you that patient has severe adhesions so the pericardium is all clumped up.

Ohho.

Interesting.

They didn't just drill a hole, but they threw up a safety net like a hammock so the heart wouldn't leap out.

At that moment, Professor Han Hyeon-jae nudged the surrounding tissue with his forceps and shifted his gaze.

“Resident Hyeonjae. Look closely. Because now we're going to trap this guy.”

“Are you using the Pericardial fat?”

“What? No, no.”

Han Hyeon-jae shook his head firmly.

“This hole we made right now is about 3 to 4 centimeters, and applying a thin fat pad attached to the outside of the heart on a hole this size is a bit unreasonable. It will tear or get pushed out by the pressure of the beating heart. Here, we're going to strip and use a tough and strong intercostal muscle flap.”

It meant stripping the tough muscle tissue between the ribs and applying tension to stitch it across like bars.

“Ah…. I learned something.”

When I genuinely marveled, Professor Han Hyeon-jae chuckled and picked up his scissors.

“What do you mean learned. It's not like you're even coming into our department's surgery.”

He threw a light scolding that was half-joke and half-truth, and began to separate the intercostal muscle with skillful hands.

…

…

The hallway of the guardian waiting room in front of the operating room.

Thanks to the professor's artistic hand movements, the surgery was concluded very successfully.

I finished changing clothes and walked down the hallway.

“…For now, the emergency surgery ended safely. For now, if we watch the progress intensively in the ICU and wait for recovery….”

A warm and reassuring voice.

‘He's consulting with a guardian.’

I stood at a distance so as not to interfere.

Han Hyeon-jae, who sent the guardian back, turned around and spotted me.

“Oh, Resident Hyeonjae. Good work.”

“Not at all. You are the one who worked hard, Professor.”

“Getting dragged into an emergency operating room from the first day of dispatch. Listening to complex thoracic anatomy about the heart and lungs that you aren't familiar with, you must have gone through a lot of trouble. Thank you for following along well silently by my side.”

Certainly, except for when he fiercely reamed Hong Seon-ho in the operating room earlier, his usual personality was that of a truly good person.

“Ah, no. I learned a lot while watching an excellent surgery.”

“So, what are your thoughts about my suggestion earlier?”

The suggestion to come to Thoracic Surgery after finishing Emergency Medicine training.

I felt cold sweat trickle slightly down my spine.

“Ah… that is, I will think about it.”

‘Fuck.’

A double curse popped out inside me.

Blatantly in front of the professor, I couldn't say:

‘The medical center director told me to secretly prepare a ghost department so I can cross all kinds of clinical departments and grab a knife! So I can't be ground into just Thoracic Surgery alone!’

If I said that, I'd immediately be treated as a mythomaniac patient and a consultation to Psychiatry would clearly fly out.

At my vague and conventional answer, Professor Han Hyeon-jae grinned.

“Well… yes. I can't drag you here forcibly. Ah, it's already lunchtime.”

He glanced at the clock hanging on the wall.

“Since you worked hard from the morning, eat food and get some rest. Let's meet at the 7th-floor conference room at 1:20 later.”

“Ah, yes. Please go on in, Professor.”

Professor Han Hyeon-jae waved his hand and moved away.

‘Is the schedule for a dispatched student relatively easy?’

After doing the morning rounding and watching one surgery together, he just sent me away to eat right away.

The real hell would be the share of the Thoracic Surgery residents.

I got into the elevator, pressed the close button, and fell deep into thought.

In the past, because of urgent patients dying right before my eyes, I forced myself to step forward and badgered the ghosts to beg for knowledge, doing crazy things to save them without looking back or forward.

Just because I wanted to live, or because I wanted to save them.

But as those crazy things overlapped and piled up, before I knew it, my goal had changed from a pay doctor to a proper professor.

And the gaze of the inside of the hospital toward me had completely changed too.

Somehow, I was packaged as a genius resident and had now become an ace that professors from other departments openly coveted.

‘Like the Q&A in the operating room today….’

Now, even when it wasn't an urgent situation where a patient's life hung in the balance, I cheated on the ghosts' knowledge to answer without a hitch to the professor's questions and get a good evaluation.

In a way, the legacy of these great medical scientists was being utilized as a means for my promotion and to take the elite course.

I wonder what the ghosts think about this.

Wouldn't they find it distasteful that their great knowledge was being used for an individual's success?

[Dead Medic Gallery]

Guys

Author: Korean Slave 1 (Male)

In the past, I only asked the gallery members to share information when it was urgent to save a patient, but lately, I feel like I'm just using your knowledge to hit the correct answers in the operating room and do well for myself.

Is it okay to do this…?

It was a confession that was serious in its own way.

As soon as the post went up, familiar notification sounds rang out.

[Comments]

Mes of the God (Male): We just do it for the taste of reaming a newbie. Seeing you get stripped is my only joy.

Latte is Mine: If you're disappointed because internal medicine patients aren't coming in lately, upvote lol

Let's Roll the Catapult: Upvote lol

Rheumatology Old Woman: What is an upvote? Is it something to eat?

“….”

I, who had seriously agonized over ethics, was a fool.

They were merely back-room coaches who enjoyed this situation itself and were crazy about medicine even after death.

They didn't give a damn about my success and were merely satisfied with indirectly experiencing the living, breathing hospital field through my eyes.

I smiled blankly, looked at those comments, and quietly turned off the window in the void.

Flash.

Well.

If I do well, it's good for them too.