Chapter 222

Episode 222 Pixie (5)

“Mosquito, please.”

Swwish—

My hand, controlled by Mes of the God (Male), widened the subcutaneous fat layer and secured the field of view without a moment's hesitation. The resistance of the raw flesh felt through my fingertips was transmitted with chilling vividness.

“Mezenba… ah. Yes. That. Metzenbaum. Yes.”

When the nurse momentarily confused the names of the instruments and tried to pick up regular scissors, Mes of the God (Male) corrected her very gently. If it were the usual Mes-God bastard, he would have shouted, “Not that, Metzenbaum!” Perhaps he had finally realized he was borrowing someone else's body, or maybe he was originally kind to the assistant, but he was surprisingly gentle.

Swwish—

The Metzenbaum scissors passed to him pierced into the subcutaneous tissue, opened up, and perfectly performed the blunt dissection. The yellow fat layer split to both sides, opening a path toward deeper structures. Externally, Mes of the God (Male) maintained an unexpectedly mannerly tone while dissecting the subcutaneous tissue. Of course, the inner thoughts echoing in my mind were completely different.

『If we assume there is no bleeding pouring out externally and it's just packed with bruising and a hematoma inside, it means the artery itself isn't completely severed.』

As Mes of the God (Male), holding the knife, muttered inwardly, Operating Room Ghost 3 (Male), who was floating in the void, snapped back as if he had been waiting.

『What do you mean assume there isn't? It’s an intimal tear. Study vascular pathophysiology a bit harder.』

『I know. I forgot for a split second, so understand.』

The two ghosts were busily exchanging opinions without rest. Listening to the rough tiki-taka of the old-timers echoing in stereo while sharing my brain, my mind, sitting in the spectator's seat, was on the verge of becoming faint. However, unlike that noisy internal situation, my two hands were moving with a precision and elegance that was nothing short of miraculous.

Descending through the fat layer, the tough, white fascia lata wrapping around the thigh muscles finally revealed its taut form. Mes of the God (Male) lightly snapped the wrist holding the No. 10 blade to make a small incision on the white fascia.

“Mayo, please.”

Just as the heavy Mayo scissors, specialized for cutting tough tissue, were about to be handed into his hand, Im Seonghyun cautiously opened his mouth.

“Teacher. I mean, even if we overlook up to the shallow subcutaneous layer, from the detailed fascial incision onwards, I should… no, wouldn't it be better if I did it? The nerves could get damaged.”

Seeing an Emergency Room resident fearlessly pushing a knife right up under the jaw of the femoral artery, it seemed that anxiety had crept in no matter how urgent it was. It also meant he would take responsibility.

'That's pretty cool.'

Seeing that he has a sense of responsibility.

He's a cool doctor.

However, Mes of the God (Male) did not hand over the hand holding the scissors.

“Just a moment.”

While Im Seonghyun withdrew his hand, Mes of the God (Male) carefully slipped the lower blade of the Mayo scissors through the hole he had made and demonstrated cutting the fascia longways up and down.

Swwish—!

The tough fascia opened up cleanly in a perfect straight line, as if paper were being torn. Witnessing that hand movement right before his eyes, Im Seonghyun quietly started assisting again.

“Open the retractor a bit.”

“Ah, yes.”

Without a word, Im Seonghyun hooked the iron-claw-shaped retractors on both sides and pulled the incision wide open. Only then did the femoral vascular sheath, hidden beneath the fascia, come into view, completely frozen cold without even a hint of throbbing.

“I'll try touching the vessel now.”

At the same time Mes of the God (Male) opened his mouth, the nagging of Operating Room Ghost 3 (Male) dropped from the void.

『Use the Bovie to open it, you Mes-God bastard! Burn your way in!』

『I know.』

Hearing the two of them talk without rest in my mind, my head was honestly getting a little dizzy.

Taking the Bovie, Mes of the God (Male) began to peel away the vascular sheath very thinly. The suction drew in the smoke rising with a sizzling sound. Then, the true form of the bruised and distended common femoral artery finally revealed itself intact. A normal artery should repeat vigorous expansion and contraction while displaying a clear bright red color, but the blood vessel revealed before my eyes was hardened solid with blackish-red bruising. The intima torn by the impact of the blunt trauma and the accumulated thrombus had puffed the blood vessel wide open.

From here on, it was the domain of real skill. The internal anatomical structure is no different from a minefield. The giant common femoral vein running medially, the femoral nerve stretching down along its lateral side, and even the branches of the great saphenous vein passing chaotically over the surface. The two hands of Mes of the God (Male) began to isolate only the artery with extreme meticulousness so as not to damage all these structures.

He gently pushed a right-angle Kelly with a very soft tip along the side of the artery, gradually widening the surrounding connective tissue. Touching the nerve would paralyze leg sensation, and tearing the vein would cause unmanageable massive bleeding. Only the single artery whose breath was stopping had to be isolated.

“I will place a vessel loop. DeBakey, please.”

Having secured both ends of the artery, which were healthy and alive where the thrombus had not yet propagated, Mes of the God (Male) instructed. With the DeBakey forceps, Mes of the God (Male) gently grasped the healthy arterial wall proximal to the vessel damage site, and with the other hand, carefully passed the right-angle clamp held in his hand through the narrow, dark empty space behind the artery.

Swwish.

As the tip of the clamp, having perfectly passed between the posterior wall of the artery and the vein, poked out pointedly on the opposite side, he hooked a blue silicone loop and pulled it smoothly behind the artery. A snare to block the clogged blood vessel up and down was installed.

“Trauma Surgery teacher?”

“Yes, Teacher.”

Im Seonghyun, whose title and attitude toward me had completely solidified into honorifics before anyone noticed, answered while tightly tense.

“I'll pull the loop, so please clamp the vessel loop.”

“Ah, yes.”

Im Seonghyun waited with a mosquito. In that fleeting moment.

『Old man, old man.』

Mes of the God (Male) urgently called out to Operating Room Ghost 3 (Male) in the void inwardly.

『What. Why are you suddenly looking for me while doing fine with the surgery?』

『We loop this around once and clamp it right away, right? Because the arterial pressure is strong, it'll slip with just one loop.』

『Right. You're meticulous.』

『Because that's my job.』

As soon as the end of the vessel loop was bitten by the right-angle clamp, Mes of the God (Male) gently pulled it to wrap the vessel tightly. Then, using the same method, he repeated the exact same process on the lower part of the damaged site to pass a red vessel loop over.

“Tying.”

As Mes of the God (Male) pulled the loops hooked by both hands tautly up and down, the plump artery was squeezed tight.

“Now!!”

Taking advantage of that gap, Im Seonghyun fixed the root part of the taut loop with a clamp, completely blocking the arterial blood flow. Now, the section filled with blood clots was perfectly isolated up and down. The stage to slice the blood vessel open and shove in the shunt pipe was completed.

“Did 5000 units of heparin go in? The moment we slice the vessel, the blood must not clot.”

Borrowing my mouth, Mes of the God (Male) threw out the final check.

“Yes, yes~ It has fully circulated through the whole body!”

“Yes, good. No. 11, please.”

“Here it is.”

As soon as the scalpel was handed over, a booming lecture resonated inside my head as if it had been waiting.

『Perpendicular, perpendicular! Just like earlier! Stab it exactly upright, vertical to the vessel wall!』

『No, I told you they do shunts a lot in trauma surgery too. I know.』

Mes of the God (Male) grumbled and replied inwardly.

『Even so, what can I do if I'm nervous! I can't touch the vessel directly with my own hands, and yet I can't just sightsee around with a comfortable mind because I'm worried you'll make a mistake!』

『If you're frustrated, go look at that fascinating touchscreen monitor instead. Don't screech into my ear and break my concentration.』

'Pfft.'

At the critical moment dividing life and death where the tip of the knife was, the sight of the two legendary old-timer ghosts bickering in their minds using my head as a speaker was quite funny.

Mes of the God (Male) held his wrist holding the No. 11 blade rigidly perpendicular and stabbed it into the center of the common femoral artery area, which was discolored blackish-blue and puffed wide open.

Thump—

With a resistance like puncturing a tough rubber tube, a small incision was pierced.

“Potts, please.”

“Yes.”

The Potts scissors, specially angled for blood vessels, were placed in his hand. Mes of the God (Male) pushed the scissor blade into the narrow gap made by the No. 11 scalpel and flung the lumen of the artery wide open vertically.

Snap—

As soon as the vessel lumen opened, the horrible reality was revealed to the naked eye. An intimal flap torn and rolled up by the powerful blunt trauma. And it was a mass of blackish-red mural thrombus sticking to the surface, tightly blocking the narrow blood vessel like concrete.

However, scooping out only the visible thrombus was not the end of the matter. Since numerous thrombus pieces had already been pushed down below the rupture site, necrotizing the leg, they had to be dragged out. The possessed Mes of the God (Male) and my consciousness reached the same conclusion at the same time.

“Now…”

Mes of the God (Male) tore open the packaging of the special catheter that Baek Eunseo (Female) had run up and borrowed. A long, slender 4-French Fogarty catheter with a very small rubber balloon attached to the tip. Mes of the God (Male) shoved that slender tube deep into the distal part toward the toes through the arterial incision.

“Syringe.”

With the syringe passed to him, Mes of the God (Male) inflated the balloon at the tip of the catheter by about 2cc. Mes of the God (Male) held his breath and began to drag the catheter outward.

Swwish—!

The balloon scraped along the narrow inner wall of the artery as it was drawn up. And the moment the balloon popped out of the incision, long, trailing tails of thrombus began to be scraped out externally and discharged.

“Suction!”

As the blackish-red blood clots poured out in chunks, Im Seonghyun approached with the suction machine in horror. It was then.

Whirrrr—

The automatic door of the Resusc opened noisily.

“I came from Vascular Surgery, but by any chance, the bicy… cle… pati…”

The one who entered the Resusc panting as if he had run in hot haste was a general surgery resident. He must have rushed down from the OR upon receiving the call that the patient's leg was rotting. However, his words could not meet their end. As the general surgery resident's jaw dropped, Mes of the God (Male) casually nodded his head and answered.

“I am inserting a shunt. Just a moment.”

“Ah… that… yes?”

Ignoring the general surgery resident's mind-blanked expression, Mes of the God (Male) leisurely gave the next order.

“Let's insert the shunt and send him up to the OR.”

When he finally slightly loosened the proximal vessel loop, clean, clear arterial blood pumped down from the heart backflowed and surged up. Mes of the God (Male) nodded his head with satisfaction.

“I've scraped out all the thrombi. I checked that blood flows well up and down. Now we should put in the shunt.”

“No, that… Teacher. Directly right here right now…”

The confused general surgery resident approached to stop him, but.

“You know we shouldn't move him right now, right? Shunt, please.”

“…Yes. I will be waiting.”

Suppressed by the energy of the legend who had held a knife for dozens of years, the general surgery resident quietly began to guard the front of the Resusc door while stepping backward as if possessed by something.

Mes of the God (Male) received the transparent shunt handed over by the nurse. Then, he shoved both ends of the tube into the upper and lower severed surfaces of the split femoral artery, and began to connect the middle as if joining a broken leg.

“Loosen the vessel loop.”

“Ah, yes!”

As he loosely let go of the silicone string that had been blocking it, Im Seonghyun quickly released the clamp.

“2-0 silk, please.”

“Yes.”

Receiving a thick, strong thread so that the transparent shunt tube would not slip out from inside the blood vessel, Mes of the God (Male) began to tie down the shunt tightly from the outside of the vessel.

“I will tie.”

…

…

“Opening the blood flow.”

The moment the final knot was made and the shunt was completely opened. The bright, vivid red arterial blood pumped from the heart began to pour down ruthlessly toward the leg, riding through the transparent plastic tube. At the same time, IV fluid began to enter along the line poked into the patient's arm. It was a miraculous moment when the warmth of life began to circulate at the patient's toes again.

“Give me the Doppler.”

As Mes of the God (Male) picked up the portable Doppler and placed it on the patient's left instep area. Where it had been quiet as if dead earlier, a vigorous arterial pulsation of a triphasic wave could be verified.

“Phew…”

All the medical staff inside the Resusc exhaled a sigh of relief at the same time. They saved the leg. They saved the patient's life too.

Mes of the God (Male) flung off his blood-stained gloves and called the general surgery resident who was standing blankly by the door.

“The teacher who came from Vascular Surgery?”

“Ah, yes Teacher!”

“Emergency treatment from the trauma team is finished. For now, we made the cut-off blood flow through with a shunt to save the leg. Since we've bought some time, let's move him to the operating room now.”

“Ah, ah yes! Thank you for your hard work!”

Listening to that brazen line from a corner of my consciousness, I admired slightly.

'Trauma team, huh…'

He implicitly hid the fact that an emergency medicine doctor performed the surgery.

'Surprisingly, he occasionally has parts where he has this kind of hospital politics awareness and tact.'

Albeit very occasionally.

While setting up the patient transport, the general surgery resident could be seen in the corner sweating over the phone.

“Ah, about that, Professor… the reason the patient bed hasn't come up yet is, they did a shunt in the emergency room… Yes? No, it wasn't me who did it…”

As the resident, who hadn't fully grasped the situation, stammered, Mes of the God (Male), unable to watch any longer, strode over and made a gesture asking for the cell phone.

“Give it here.”

[Hello? Hey, Kim Seungju. Speak straight. A shunt in the ER…]

Mes of the God (Male) cleared his throat once, and then began to pour out a briefing in a voice so calm it was unbelievable for an old man who was spitting double curses until a moment ago.

“Patient is a 17-year-old male, a case of motor scooter handlebar syndrome. Upon presentation, loss of pulse and ischemia in the left lower extremity, and signs of shock were observed, so after taking a CTA, we diagnosed left common femoral artery occlusion and thrombosis.”

A perfect medical history report poured out without even taking a breath.

“Because time was delayed, the trauma team directly performed a cutdown in the ER, removed the thrombus with a Fogarty catheter, and temporarily inserted an Argyle shunt, currently restoring the instep pulse. Vitals have stabilized, so we are sending him up to the OR right now.”

[Ah, ah, is that so?]

Professor Song Jiyeon on the other side of the handset also seemed suppressed by that overwhelmingly flawless briefing, as her voice softened.

“You'll have to open the operating room and check, but since the arterial wall damage site reaches 4cm, a primary anastomosis simply pulling and sewing the vessel seems impossible due to tension. Since we sanitized the right leg together earlier, it looks like you'll have to harvest the right great saphenous vein right away and connect it with an interposition graft.”

[Ah, aaah, right. The trauma surgery must have gone through a lot. By any chance, the name of the teacher who is reporting over there is?]

Professor Song Jiyeon left high praise and asked for the name of the trauma surgery doctor who led this outstanding treatment.

Mes of the God (Male) lifted the employee ID card hanging around my neck with his finger and answered clearly toward the phone.

“Han… Hyeonjae.”

[Uh?]

“I am an Emergency Medicine resident.”