Chapter 214

Episode 214 Crazy Guy (3)

"Pardon? It's not?"

Jeong Jaesang approached me and stopped, his eyes wide with surprise. His voice was full of bewilderment and embarrassment.

It was a natural reaction.

In the emergency room, the Emergency Medicine department had judged it to be a thoracic disease and handed it over. The on-duty doctors from Cardiology and Thoracic Surgery had finished the primary screening, and Professor Ju Gwangho, an aorta specialist, had personally received the call and ordered the operating room to be prepared.

Yet, a visiting resident had just glanced at the tablet screen and was now putting on the brakes, claiming the diagnosis was wrong. From Thoracic Surgery's perspective, it was bound to be absurd.

I stared intently at the CT monitor indicated by the ghosts and replied.

"Yeah. From what I see..."

I let my voice trail off.

Since I was trying to speak with 100% certainty based on the knowledge from the blue window rather than my own, my mouth felt dry. This was a critical matter that would completely change the surgical approach and prognosis.

Seeing my stiff expression, Jeong Jaesang let out a short sigh and pierced through to the core.

"But teacher, is the disease you suspect something that requires an OP, or is it a disease that just needs medical treatment?"

"...Uh. We probably have to do surgery."

I nodded my head.

Whatever it was, if the ascending aorta had swelled up to 5.2cm and was on the verge of bursting right now, opening the chest was all the same.

"Then let's go and talk."

Jeong Jaesang took back the tablet from my hand and quickened his pace.

"We don't have time to be doing this here right now. They said a rupture is imminent... so it's quite urgent. If the patient's blood pressure spikes just once, they will expire right on the spot."

"Ah, right. Let's do that."

He was right.

The clock in Thoracic Surgery runs twice as fast as in other departments. Following behind Jeong Jaesang, I started running across the hallway bridge.

Finally, the entrance to the operating room located at the end of the bridge appeared. Panting for breath, I stood in front of the hectic emergency operating room access control machine. I tapped the ID card hanging from my neck against the reader.

Beep—

[The door is opening.]

The moment the door slid open to both sides.

"What did you say?!"

Someone's urgent and sharp shout echoed loudly down the operating room hallway, hitting my eardrum.

"Esmolol, Esmolol! I loaded 35mg by verbal order!"

A youthful voice, unclear whether it belonged to an ER nurse or an anesthesia resident, shouted loudly.

"Ah, I got it!"

I could see a gurney carrying the patient entering the operating room with a noisy sound from its wheels. Around it, five or six medical staff members were clinging together, squeezing an Ambu bag and running with a monitor, creating a chaotic mess that resembled a war zone.

Jeong Jaesang pulled on his surgical cap and spoke to me.

"It's completely chaotic, right?"

"Yeah, very chaotic."

I swallowed hard.

We approached the scrub station in front of the operating room at a fast pace. Beyond the operating room window, I could see the silhouette of the anesthesia department fighting a desperate battle to put the patient to sleep.

And before my eyes stood a large doctor, scrubbing his forearms vigorously with a betadine sponge to put on a sterile gown.

Professor Ju Gwangho, head of the aorta section.

I carefully approached the side of the sink where water was pouring out in torrents.

"Professor Ju."

Professor Ju Gwangho, who was scrubbing, turned his head sharply at my voice carrying over the sound of the water.

"Uh, the visitor? Why is the visitor here..."

His brow furrowed.

He looks incredibly scary. Are all thoracic surgeons naturally like this?

Faced with the pressure of interrupting the chief surgeon right before surgery, I inadvertently stammered my words.

"That... uh..."

"Why? Quickly."

Professor Ju Gwangho raised both arms, shook off the water, and cut me off irritably.

"I'm busy. This patient is Type A, so I have to get in quickly and open the chest. If I waste time here, I don't know when it will progress to a dissection and compress the heart. Is there some big problem in the operating room?"

He was right.

An aortic disease is a condition where the survival rate drops by the second. Even at this very moment, the blood vessel wall, unable to withstand the blood pressure, might be tearing apart.

However, the analysis of the ghosts kept swirling in my head. If that wasn't a hematoma but caused by an infection, everything from the type of artificial blood vessel used during surgery, the antibiotic treatment, and even the extent of the excision could get entirely messed up.

I took a deep breath and opened my mouth.

"Yes. I think there is a probability that the patient does not have an IMH."

Whoosh—

Only the sound of water flowing from the sink filled the space between the two of us.

"I don't have the luxury to listen to nonsense from a visiting resident."

Before I could even finish my words, Professor Ju Gwangho turned his head away coldly. His gaze was no longer on me, but already fixed beyond the window on the patient on the operating table, where the anesthesiologists were fighting their battle.

An aortic rupture was imminent. In a situation where the timer of a time bomb was running wildly toward zero, a clumsy medical tackle from a resident of another department was nothing more than annoying noise.

Thump.

Professor Ju Gwangho stepped on the bottom switch with his foot.

Whirrrr—

The heavy automatic door of the operating room opened, and as he stepped inside to put on a sterile gown, he spoke.

"If you're coming in, wash your hands. Put on a gown and observe without getting in the way. If you're going to talk nonsense, just watch from the outside."

"...Ah."

An eviction order had been issued.

As the door closed, only Jeong Jaesang and I were left standing blankly at the scrub station. Jeong Jaesang looked at me with a troubled gaze.

"Teacher. For now, think about it slowly and then come in." He spoke soothingly as he picked up a betadine sponge. "I know you felt something was strange after looking at the CT earlier... but honestly, isn't it the same anyway? You open the chest, stop the extracorporeal circulation with a heart-lung machine, and swap it out with an artificial blood vessel. Whether it's an IMH, a dissection, or whatever else you suspect. The surgery itself doesn't change."

It was an extremely practical approach, typical of a surgeon.

Whether the pipe was rotten or couldn't withstand the pressure, if it was right before bursting, you cut it out first and connect a new pipe. It meant that the detailed medical treatment based on the specific diagnosis was a matter for after keeping the person alive in the operating room.

"Ah, yeah. If it's according to my thoughts, that's true..." I answered with a lingering sense of discomfort.

He wasn't wrong.

"Come in slowly, teacher. I'm heading in first."

Jeong Jaesang raised his washed arms and disappeared into the operating room. Left alone, I closed my eyes.

Replacing a pipe. Yes, replacing it.

But what happens if you forcibly try to sew a new pipe onto a rotten, paper-thin pipe? The tissue will tear at every needle hole, and an uncontrollable major hemorrhage will erupt.

'Depending on what the underlying disease is, the state of the blood vessel tissue is completely different...'

I quickly started reasoning. If my own head wouldn't work, I could just borrow hundreds of years' worth of brain cells.

I immediately ran to the public computer in the corner of the scrub station used for prescriptions and reviewing images. I tapped the keyboard, entered the patient's registration number, and pulled up the fresh chest contrast-enhanced CT that had just been taken; the image popped up immediately.

I rolled the mouse wheel like crazy.

Axial, coronal, sagittal.

After pulling up the views alternately, I moved so close that my nose almost touched the monitor, examining the aortic arch and the area around the ascending aorta. Then, I took a picture of that screen and transmitted it to the void window.

[Dead Medic Gallery]

Korean Slave 1 (Male): (Video)

Mes of the God (Male): Oh boy.

Operating Room Ghost 3 (Male): The shape of the thickened blood vessel wall looks a bit round. It's not a typical crescent-shaped hematoma, is it?

'...That's true?'

If it were an intramural hematoma, the blood should pool to one side, making the wall thicken into a crescent shape. However, this patient's aorta had the entire pipe swollen evenly and roundly.

Mes of the God (Male): Do you see those white shadows around the aorta?

Mes of the God (Male): It's fat stranding. The thickening pattern is way too uniform. It's not that blood has pooled, but the blood vessel wall itself is swollen from inflammation. If so, it's not an IMH that burst due to blood pressure.

Cardiology Ghost: It's not just the ascending aorta; it's hypertrophied all around the upper aortic arch and the blood vessel branches going up to the neck. It's a finding of aortitis.

Aortitis. Inflammation.

I tapped the keyboard and this time pulled up the ER initial examination printout sheet, the triage sheet, and the blood test lab results as a whole.

'In addition to this... even the ER medical records.'

Click.

Korean Slave 1 (Male): (Picture)

Latte is Mine: Unexplained systemic fatigue and intermittent night fever over the past two weeks. They went from clinic to clinic thinking it was just a cold or body aches, and then came in today because chest pain suddenly erupted.

Hippocrates' Descendant: Oho! Look at that written in the corner of the chart! There is also jaw claudication! They stated that their jaw hurts when chewing food, so their appetite dropped! Living doctor, this disease is...!

Ah.

A very rare and fatal disease name that I had only seen in print within rheumatology and cardiology textbooks.

I got it.

The ghost's chat and my lips moved at the exact same time.

Hippocrates' Descendant: Giant Cell Aortitis.

'Giant cell aortitis.'

The inner wall of the blood vessel hadn't torn because of blood pressure. The immune system had attacked the aortic wall itself, causing inflammation and melting the blood vessel to make it weak like tofu, and it had ballooned up after taking the pressure.

'Opening the chest and doing needlework in this state? Moreover, if the inflammation has eaten into the aortic arch, the range of replacement isn't going to stop at the ascending aorta...'

I pushed away from the monitor and dashed to the sink.

Splash!

Hastily stepping on the pedal to turn on the water, I rubbed my hands and forearms frantically with a betadine brush. I didn't even have the luxury to follow the standard textbook protocol for a surgical scrub.

I rubbed my hands like crazy, rinsed them with water, and while holding both arms up, kicked the switch of the operating room door with my foot.

Whirrrr—

The cool air inside the operating room and the bright light of the surgical lamp poured out. I slid my arms into the sterile gown that a nurse spread out for me and walked toward the operating table.

I didn't forget to display the blue window in the void, either.

'Um, okay. Okay. Let's headbutt it.'

The patient was already draped, with only the chest area exposed in a square. The anesthesia monitor was making a steady mechanical sound, and a fellow standing in the first assist spot and Jeong Jaesang in the second assist spot were waiting while holding the suction and retractor.

And at the center of it all, Professor Ju Gwangho, holding a scalpel, was looking at the patient's epigastrium.

Professor Ju Gwangho merely glanced over with his eyes to check my presence and spoke coldly.

"Visitor, stand over there on the footstool."

The moment his hand was about to slice downward.

"Professor. I have one word to say—"

"Han Hyeonjae!"

As soon as I opened my mouth, Professor Ju Gwangho roared out. The entire operating room vibrated loudly.

"How many times do I have to tell you that if we don't run the pump right now, the aorta will burst and they will die! Are you my fellow?! Are you my resident?! Why! What is it?!"

A shout dripping with murderous intent.

Normally, I would have shrunk back here, saying 'Sorry'. There was absolutely nothing good about upsetting a professor's mood.

However.

"It's giant cell aortitis!!!!!!!!"

A voice loud enough to make the veins stand out on my neck erupted from my throat.

"...What?"

Professor Ju Gwangho's hand, which was about to lower the scalpel, flinched and stopped.

I don't care, fuck it.

Anyway, my nickname in the emergency room was one of Cheongjin University Hospital's ER top three crazy guys. If they won't listen when spoken to politely, I have to bark to make them stop.

Because I absolutely hated to see a patient, who could be saved right in front of my eyes, die on the table due to a wrong surgical plan. I might as well become the second Mes of the God.

Just headbutt it.

"It's not an IMH, it's an acute aortitis caused by GCA."