Chapter 246

Episode 246. How to Save Two People (3)

Thump—!

The moment the aircraft settled onto the rooftop helipad, I threw open the helicopter's side door.

"Ah, shit."

As the door opened, a fierce gust of wind whipped up by the still-spinning helicopter propellers blasted into my face, forcing my eyes shut. Now was not the time to be distracted by the wind. Raising my head, the first thing to enter my field of vision was the panicked face of the OB/GYN resident on duty.

They had likely rushed up to wait after receiving only the brief piece of information that a full-term pregnant patient was being transported via helicopter. However, the moment the door opened, they caught sight of the medical team performing Cardiopulmonary Resuscitation on top of the patient's chest, which seemed to strike them with shock.

Even so, you shouldn't be doing that. At least you're a doctor.

"Uh, a-arrest...?"

"Move out of the way!" I bellowed as soon as the helicopter door swung open.

It was already hard to hear due to the helicopter noise, so what the hell were they doing standing around in a daze? For now, I had to deliver accurate information as quickly as possible—even by a single second—and control the line of movement.

"The patient just went into arrest a moment ago! We're moving her straight to the Resusc!"

"The Resusc? Are we not going to the delivery room?"

"Then should we head straight to the East Wing delivery room from here?!"

Thinking about the building layout of this uselessly large hospital, doing that was no different from a suicide mission. Right now, we were on the rooftop of the Emergency Medical building. From here to the Resusc, it was a one-minute trip if we just took the elevator and shot straight down to the 1st floor.

But what if we headed for the OB/GYN delivery room located on the 5th floor of the East Wing, or the main building's Operating Room? We would have to take the elevator down, cross the connecting walkway, and then catch the East Wing elevator all over again. Even if we sprinted while pushing the stretcher at a crazy speed, it would take at least three minutes. If it dragged on, it would exceed five minutes.

"There's no time for that!! We're moving her right now!"

Four minutes after cardiac arrest. Because the uterus compresses the vena cava and blocks blood from returning to the heart, if the abdomen isn't cut open to extract the fetus within four minutes, both the mother and the baby will suffer brain death or perish.

Lifting my gloved wrist, I checked the position of the hands on my watch. The current time was 15:16. I pressed the watch button to start a 4-minute timer.

"Moving her! One, two, three!"

Myself, the flight nurse, and the OB/GYN doctor—who had finally snapped out of their daze—all latched on to transfer the patient from the helicopter bed to the hospital stretcher. The moment the full-term patient's body shifted onto the stretcher, all of us sprinted toward the elevator, pushing the stretcher so hard it felt like the wheels might shatter.

Clack-clack-clack-clack—!

'Please, let the pulse return while we go down. Anything but a PMCD...'

PMCD. Perimortem Cesarean Delivery.

A procedure where the abdomen of an unconscious mother is sliced open with a scalpel right on top of a dirty Emergency Room Resusc bed—where perfect sterilization and anesthesia are impossible—to pull the baby out. I really didn't want to do this. So, please.

'Come back.'

Beat again, heart.

"What are you doing! Shift chest compressions! If you lose strength, the compression depth won't be enough!" I shouted the moment we arrived in front of the elevator.

Because I had been pressing down on her chest without a break since we were inside the helicopter, it felt like my arms were completely out of strength.

"Ah, yes!"

At my words, the nurse quickly climbed onto the stretcher and started compressions. Verifying that the nurse had begun, I hurriedly pulled my phone out of my gown pocket and dialed the Emergency Room station. The air inside the elevator felt strangely heavy.

I had to do the most important thing. What was it? Conveying information right away.

Ring-ring-ring—

Ring-ring-ring—

'Pick up quickly, come on.'

No, usually they answer immediately when a call comes in. Is it just my imagination that they seem to be picking up late today of all days? It must be my imagination. Just then, the ringing cut off and a voice came through.

[Yes, Cheongjin University Hospital Emergency Medical...]

"I'm 4th-year resident Han Hyun-jae! We intercepted the helicopter patient on the rooftop and are heading down! The patient just went into arrest, and instead of the delivery room, we're going straight to the ER, so set up the Resusc immediately!"

[Pardon? A full-term mother is going to the Resusc instead of the delivery room?]

It made sense that they would ask, since a pregnant patient should unconditionally be sent to the OB/GYN area. Normally, even when pregnant patients entered the hospital through the Emergency Room, if they were full-term and about to give birth, they wouldn't even lie down on an ER bed before being sent to the delivery room.

But right now, this wasn't one of those times.

"I said there's no time! If we can't get the baby out within four minutes, both of them die! Pop open the PMCD tray right now and have it ready next to the Resusc bed!"

[That... to set it up right now will take a bit of...]

"Hurry!!!"

A massive voice exploded from my throat, surprising even myself.

[Ah, yes, yes! Understood!]

Whew.

I hung up the phone. My hands were trembling violently. Cold sweat rolled down my forehead and stung my eyes. Time would not wait for us. And the time that refused to wait would snatch away the lives of both the mother and the child. Every single minute and second was precious...

'It's terribly slow, this thing.'

I had become so sensitive that even the elevator irritated me.

'Please, just move.'

Ding—

[1st floor.]

[The doors are opening.]

Along with the announcement voice, the elevator doors slid open. At the same time, the first thing to enter my sight was the figure of 3rd-year Emergency Medicine resident Baek Eunseo, who had already finished completely controlling the line of movement and was waiting with the Resusc doors open.

'Smart.'

She had perfectly understood my instructions, blocking the view of the patients in the general area while securing the entry path flawlessly so the cart could charge straight ahead without catching on even a single centimeter. As expected, a 3rd-year's experience wasn't just for show. I had always thought she was quite bright theoretically, but lately, her situational awareness and practical skills had significantly increased. She was truly shining today.

Rumble-clack—!

The stretcher entered the Resusc area.

"Take out the backboard, take it out! It's not trauma, so clear out the thing slid under her back!" I shouted, panting for breath.

"Ah, yes!"

"Alright, shifting the patient to the bed! One, two, three!"

Thud—!

"Checking rhythm! Stop compressions!"

The moment I shouted, the nurse who had been pressing the chest pulled her hands away. Everyone's eyes simultaneously turned to the EKG monitor hung on the wall.

[ - / - ]

"It's PEA! No pulse! Keep compressing!"

The heart's electrical signals were alive, but the pumping function to squeeze out blood had completely stopped.

"She's a maternal patient, should we attach the CTG?"

"Don't attach it!"

Checking whether the fetus's heart is beating or not only makes sense when the mother's heart is beating, so why would we attach that? When the mother's heart has stopped and blood isn't circulating, how could the fetus's heart possibly be fine?

I raised my gloved wrist to look at my watch.

'About one minute has passed since the moment she went into arrest on the rooftop earlier... the remaining time is merely three minutes.'

I felt like my blood was drying up.

"We might have to perform an immediate PMCD, so don't put anything on top of her abdomen and get the betadine ready! Rotate CPR! Give Epi 1 milligram right now!"

"Yes! Epinephrine 1 milligram going in via IV!"

At my request for a rotation, an intern who had been waiting in the corner completely terrified scrambled up onto the bed, locked their fingers together, and started compressions.

"When is the Lucas arriving?"

"Just a moment! They're bringing it now!"

Until the machine that automatically performs cardiopulmonary resuscitation arrived, we had to forcibly circulate blood using human strength. The moment I saw the posture of the intern who had climbed onto the bed, my eyes flipped. What the hell was that guy doing?

"Hey, intern!"

"Yes?"

The intern was pressing the lower half of the sternum, exactly as they had learned in the textbook. For a typical cardiac arrest patient, that was the perfect textbook standard. However, the person lying here right now was a 37-week pregnant mother carrying a fetus inside her womb.

"Three centimeters higher than that! Move up and press!"

"H-Higher? Do you mean toward the epigastrium?"

"Don't daze out, go higher!! If it's a maternal patient, the diaphragm is pushed upward! If you press there, you'll just rupture her liver and uterus, you idiot!!"

Did he not know the anatomical characteristics of a pregnant woman, where the organs inside the thoracic cavity are compressed and pushed upward because of the uterus? Or was he just panicked because the situation was too dramatic? Either way, shouting at him to snap out of it remained the same.

At my words, the intern hastily shifted his hand position higher and resumed compressions.

"The OB/GYN teacher who came down with us? Where are you!"

"Ah, yes! I'm 1st-year OB/GYN resident Yoon Yoo-jung...!" the 1st-year resident who had been standing abstractedly in the corner answered.

"Don't just stand there looking lost, come over this way and perform a manual LUD!!"

The uterus was crushing the inferior vena cava, which meant blood wasn't returning to the heart.

"Ah, that... yes! Understood!"

Yoon Yoo-jung rushed over and attached herself to the right side of the bed. Putting her weight into it, she wrapped both hands around the mother's abdomen and began pushing the uterus toward the upper left diagonal with all her might. It was a physical attempt to displace the uterus and prevent the vena cava behind her back from being compressed.

Amidst the sweat-drenched chest compressions of the intern and the treatment of the OB/GYN resident manually pushing the uterus away, the blood-drying cardiopulmonary resuscitation continued.

Beep-beep-beep—

Beep-beep-beep—

The alarm on the electronic watch strapped to my wrist began to ring. The 4-minute timer I had set on the rooftop. Four minutes had elapsed since cardiac arrest. Still, the pulse had not returned.

If we delayed any more time, brain death would hit the mother. And the fetus, which received its oxygen supply through the umbilical cord inside the womb, would suffocate to death.

'Now, there's no choice but to cut open the abdomen.'

Biting my lip hard, I summoned the blue window in the void and urgently checked the gallery. I wanted to see if, by any chance, someone who could offer urgent help was among the list of people who had recently left comments before I stepped out of the elevator. Of course, this gallery exploration must absolutely not exceed 10 seconds.

[Dead Medic Gallery]

Latte is Mine: An Internal Medicine ghost.

Mes of the God: A genius blade-wielder who earned a Double Board in GS and CS.

And the user 'NotWifeButHusband' who helped earlier, that guy...

'His specialty is gynecology, not obstetrics...'

Gynecology? Should I possess myself with a gynecologist who removes tumors from the uterus or ovaries just to get the fetus out...?

However, that fixed-ID user's recent history was despairing. A gentleman who, while alive, had opened a local OB/GYN clinic to see outpatients. A man who hadn't stepped into an operating room in over dozens of years, barely avoiding getting flamed on the forums because his theory level alone was maxed out.

Furthermore, even if a gynecologist entered the surgery, it wouldn't be of tremendous help in this current situation. The surgeries performed in gynecology are for delicately removing cancerous masses, which has a completely different nature from an emergency Cesarean section where the abdomen must be opened vertically in a rush to pull a child out in a situation where every second is precious.

If so, now when there is no obstetric ghost in the gallery, what should I do?

'Leave it to the OB/GYN resident? But she's a 1st-year...'

Me? I, a 4th-year Emergency Medicine resident, am going to do this myself?

There was no choice. Gripping the scalpel at my fingertips, without any ghost possession, relying solely on my own senses. Just as I had normally trained. Calmly.

I solidified my resolve and opened my mouth.

"Four minutes have elapsed since cardiac arrest. In accordance with the 4-minute rule, I will perform an immediate PMCD right here on this spot."