Chapter 247

Episode 247. How to Save Two People (4)

“Brighten up the lighting in the Resusc room a bit more. Focus completely on the patient's abdomen.”

At my direction, the Nurse operated the panel on the wall.

Bleep—

“Thank you.”

The shadowless lamp hanging from the ceiling cast its light down onto the abdomen of the full-term pregnant Patient.

I turned around to look at Yun Yujeong, a 1st Year Obstetrics and Gynecology Resident standing opposite me.

“Teacher Yun.”

“Ah, yes, y-yes!”

“Have you ever been in an obstetric surgery?”

“Pardon? That is…”

Of course, there was no way a 1st Year Resident who had just shed their Intern tag would have proper experience leading a C-section. She had probably only thrust a suction tip inside the Operating Room while assisting.

“I am asking if you have ever been in one.”

“Ah, ah! I have pulled the retractor from the side when Professors performed C-sections before!”

That was enough. All she needed was the muscle strength to hold it open when the abdominal wall was cut, and the concept of securing a clear view.

Whether she was excellent... I didn't know, but she was exactly the person needed right now.

“If so, stand here. Once the belly is cut, you must spread it open to both sides, no matter what.”

“Ah, yes! Understood!”

Yun Yujeong swallowed hard and took her seat.

Washing hands, which is routinely performed during regular surgery or minor surgery? Was I crazy now? Why would I spend more than 3 minutes surgically scrubbing my hands with a brush? There was no time for that.

I threw off my gloves, pulled out two layers of new surgical gloves from a sterile package, and fitted them onto my hand.

“Pour the betadine!”

“Pardon? Just—just pour it?”

The Nurse asked back in confusion. Under a normal protocol, one would soak a disinfecting cotton ball or sponge in betadine and meticulously disinfect the area at least three times, drawing circles from the center outward.

But like I said, there was no time for that right now. Why did she keep making me repeat the same thing?

“I mean, just pour the whole container over it.”

As if I was unusually frustrated today, I felt myself losing my temper without realizing it.

“Ah, yes!”

Splash—!

The container filled with disinfectant poured over the mother's abdomen. The Patient was now in a state where only a minimal, truly formal level of sterilization could be expected.

“What about the sterile drapes? Shall we cover her with surgical drapes?”

“Skip it.”

“Pardon?”

“I intend to skip it. There is no time to drape, and it will only block the view.”

We proceed like this. In the time it would take to cover her with sterile drapes and secure them with clips, a Mes would have already pierced through the abdominal wall.

The face of Section Chief Jo Kyeong-un of Thoracic Surgery, who used to emphasize Infection prevention until his mouth went dry, flashed through my mind.

'Sorry, Section Chief. Let's keep her alive first and then mix an antibiotic cocktail.'

I offered a short apology in my heart and turned my head to find the Nurse.

“Did you by any chance call Pediatrics?”

“Yes! The NICU Teacher is coming right now!”

“Tell them to come quickly. We don't know what the baby's condition will be like, so tell them to check the incubator and warmer settings again.”

“Yes, yes! Understood!”

Having finished my instructions, I placed my hand on the mother's swollen belly. Due to the chest compressions, the mother's abdomen was severely rocking up and down.

Cutting an undulating belly with a Mes. If things went slightly wrong, the tip of the Mes could pierce through the uterine wall and slash the baby's face or torso.

Whew—

'Let's calm down, Han Hyeonjae.'

I am not a General Surgery or Obstetrics and Gynecology Doctor. I am an Emergency Medicine Doctor.

However, this PMCD is an emergency skill included in the Emergency Medicine training curriculum. Even though there is almost no occasion to do it in reality, it was a skill I had simulated dozens of times by slicing open mannequins. It was a skill I had observed while doing rotations.

Above all, I had the crazy surgical ghosts, and though I couldn't call them because they weren't logged into the Gallery right now, I had the obstetric ghost.

'Don't chick out.'

I took a short, deep breath.

'Who is your teacher?'

Who else could it be?

'The dead famous doctors.'

Let's trust myself.

“We target delivery within the 5-minute golden time. Give me a number 10 blade.”

Even at this moment when I held the Mes, chest compressions could not be stopped for even a single second. Drawing an accurate incision line over the shaking abdomen was a matter entirely dependent on the operator's sense and courage.

'Incision line.'

I forcibly dragged out memories of the past.

[BabyReceiver]: If the day comes for you to make an obstetric incision, it will usually be from the Xiphoid process to the Pubic symphysis, Hell Slave! An ultra-emergency C-section is always cut vertically and cleanly! If you draw it horizontally, the baby will stop breathing!

[└ Korean Slave 1]: (Picture)

[└ Korean Slave 1]: Then based on the drawing, is it up to here?

[└ Mes of the God]: No, you bastard! Lower it more, you piece of shit!

'From the tip of the pit of the stomach to the pubic symphysis. A midline vertical incision.'

A virtual line pierced vertically long through the mother's lower abdomen. Right in the center. I captured the incision line perfectly.

'The angle of the needle.'

[Operating Room Ghost 3]: Hey!!!! I turned off the video as soon as I watched it!!!! The needle should go in at 90 degrees, you bastard! If you gouge it at 45 degrees, fuck, is this a suture??

This was not a suture, but today's incision shared the same theory. Straighten the arm. Hold the wrist firmly.

'90 degrees.'

I drove the number 10 Mes blade perpendicularly into the skin right below the patient's Xiphoid process. And without hesitation, leaning my weight into it, I drew it deep toward the pubic symphysis all at once.

Swwish—!

The skin, subcutaneous fat, and fascia split into two paths in a single stroke of the knife. Around this point, let's re-examine a question that Mes of the God hammered into my ears until they bled.

'When you slice open a belly with a Mes during cardiac arrest, is there a possibility that arterial bleeding will gush out?'

Was not the answer too clear?

No.

Red blood leaked out slowly between the incised subcutaneous fat and the muscle layer, but there was not a single drop of arterial bleeding spurting toward the ceiling.

If it were a normal surgery, I would have stopped the bleeding one by one by burning it with a Bovie, but I completely ignored the flowing blood and pushed the Mes deeper, moving on to the next layer.

I told you earlier. There is no arterial bleeding.

Rattle—!

“The NICU team is here!”

Behind my back, along with hurried footsteps, the words of the Pediatrics neonatal resuscitation team were heard. Without even looking back, I kept my focus on the Mes and calmly nodded my head.

'Handle it on your own using your wits. You know what to do, NICU Teachers, right?'

As I brushed aside the rectus abdominis muscle that way, I saw a thin, translucent membrane-like peritoneal layer exposed behind it. If I pierced just that one thin membrane, it was right into the uterus.

'If I use the knife wrongly there, it means I'll slash the face of the baby inside the belly...'

[Operating Room Wall Clock]: Look at the state of those forceps. If you crush it with that much force, it will all go necrotic later. Even pig skin has human rights, you bastard.

Snicker.

Even in the midst of this shambles, a hollow laugh leaked out. Yes. Just like taking care of pig skin's human rights, very delicately.

“Give me Russian forceps.”

“Yes, here it is!”

I grabbed the elongated forceps. As I pinched and lifted the center of the thin peritoneum with the forceps, a safe empty space was secured where the uterus and organs inside the belly would not be hurt. And I slid the scissors into that empty space.

That way, the peritoneum was completely opened from the pit of the stomach to near the pubic symphysis.

“Retractor! Quickly!”

As soon as the peritoneum opened, the expanded uterus could not withstand the pressure and surged upward. Now, to expose the front of the uterus widely, we had to hook the retractors on both sides of the abdominal wall and pull hard...

“…”

Yun Yujeong, the 1st Year Obstetrics and Gynecology Resident standing opposite me, stood frozen, completely overwhelmed by the visual of the uterus that had pierced through the abdominal cavity.

'Ah, that damn OB/GYN. She's zoning out again.'

Seeing her tremble while holding the metal retractor because she didn't know where to hook it was pitiful... pitiful, my foot. She's going to kill someone like that.

“If you can't install it, just dump the retractor! Wrap gauze around both hands, grab the abdominal wall, and pull it outward!!”

At my shout, Yun Yujeong started in surprise and threw down the metal instrument.

“Ah, ah, yes!!”

Clutching dry gauze in both hands, she thrust her hands inside the mother's open abdominal wall and pulled the muscle toward her body. The view opened up wide.

'The uterine incision site is...'

I decided. The lower uterine segment muscle layer, which has the fewest blood vessels to minimize bleeding. They said to attack the central line.

Holding the number 10 Mes again, I made a short, deep vertical incision into the tautly swollen uterine muscle.

Thump—!

Splash—!

The moment the uterine wall was pierced, the clear, warm, transparent amniotic fluid could not withstand the pressure and burst out in all directions of the Resusc room. My surgical scrubs and Gown became completely soaked with hot amniotic fluid in an instant.

'Fortunately, there is no meconium.'

If the amniotic fluid had been a murky green, it would mean the fetus had suffered stress inside the belly and discharged feces, and if it had swallowed that feces, it would have fallen into fatal respiratory failure as soon as it was born. The neonatal intubation I did last year was that case.

But at least today, it seemed there was no need to deal with that. Having checked the clear amniotic fluid, I felt a sense of relief and at the same time cast the Mes aside without regret. From now on, if I used a knife, the baby inside the belly would be hurt.

I thrust blunt scissors and my left hand deep into the gap of the incised uterus.

'Baby.'

At my fingertips, a slimy, small head was felt.

'Let's get ready to come out.'

Protecting the inside fetal head by wrapping it with my fingers, I widened the incision window of the uterine wall upward and downward. As the incision extended up and down, the uterine cavity opened completely. The fetus began to reveal its form.

I reached out both hands, gently wrapped and grabbed the fetus's head, and carefully lifted it outside the uterus.

“The head is out! Fundal pressure, please!”

The fetus's narrow shoulders got caught in the uterine incision window and did not come out well. A situation where someone had to push down hard on the top of the uterus near the mother's pit of the stomach for the baby to slide out.

“I'll do it!!”

It was Ji Yeongeun, a 4th Year Obstetrics and Gynecology Resident. Ji Yeongeun, who ran into the Resusc room panting as if she had just arrived, firmly grabbed the top part of the mother's uterus and applied pressure, leaning her weight toward the pelvis.

Slip—!

The fetus's body came completely outside.

“From the shoulder. Carefully... right. Carefully.”

Swwish—

A tiny fetus covered in amniotic fluid and blood connected with the world.

“Delivery complete!!”

I clamped the umbilical cord with two Kellys to block the blood and cut between them with scissors. When I turned my head to look at the clock, not much time had passed.

Before even 5 minutes had passed since the arrest occurred on the helicopter. Which meant, we succeeded in delivery within 5 minutes. We had kept the most perfect golden time for saving a fetus from a mother in cardiac arrest.

“Waaah—!!”

The small living thing instinctively expanded its lungs and burst into its first cry.

“NICU Teachers!!”

“Ah, yes! Lay the baby this way!!”

I carefully handed over the loudly crying baby onto the incubator of the waiting neonatal resuscitation team. That way, the precious newborn life was transferred into the arms of the Pediatrics team.

'The first goal is done.'

I took one deep breath and turned my eyes back to the Monitor.

'Now...'

Since the fetus inside the uterus was removed, the pressure crushing the inferior vena cava would have disappeared, and blood would begin to return to the heart.

'Let's go save the mother too.'