Chapter 250

Episode 250 One Doctor (2)

Korean Slave 1: Why why why why why why

Mes of the God: What happened to the mother?

Ah.

To think I forgot about this.

One of the most common and intuitive Korean names for a PMCD is none other than a "postmortem cesarean section."

As the name implies, it is considered a last resort—splitting the abdomen open under the assumption that the mother's death is a foregone conclusion, or at least to salvage the fetus inside her womb while she is dying. In other words, it is not a surgery you enter expecting the mother to make it out alive in the first place.

So, I really should have made this clear from the start...

‘From the perspective of those old bastards in the Gallery who didn't witness the situation firsthand, it's only natural for them to think I just yanked the baby out, declared the mother dead, and sent her straight to the morgue.’

Korean Slave 1: Ah, sry sry. Mother survived. Blood flow returned.

A moment after I posted my reply, notifications started flooding in.

Mes of the God: Didn't the blood suddenly spray everywhere?

Korean Slave 1: I blocked it well with clamping and packing.

Mes of the God: Packing?

Korean Slave 1: Yeah, just like you taught me.

This was the classic Mes-God style skill: blindly jamming gauze in to control the bleeding. Since I had pulled that off on an obstetric patient, I suppose that made me a fine disciple of the Mes-God.

Operating Room Ghost 3 (Male): Splendid, Hell Slave.

I interpreted that comment as a supreme compliment... for applying Trauma Surgery's inherently rough, primal method of hemostasis to an obstetric surgery without being bound by textbooks.

Well, I'm sure that's what he meant.

Thoracic Surgery Fossil: Is this really the Hell Slave I used to know? Wow, my chest is swelling with pride.

Pediatric Ghost 77: What's going on? Did you deliver a baby?

Thoracic Surgery Fossil: Said he did a C-section.

Pediatric Ghost 77: The Great Slave.

Bone Nerd 88 (Male): Did this bastard not look at the bone marrow? Even so, congratulations. You crazy, Great Slave, pulling this off.

Anesthesiology & Pain Medicine: The Great Slave.

Latte is Mine: You may descend the mountain now.

Let's Spin the Catapult: Yes, sir!

Latte is Mine: Not you, you punk.

Just when the atmosphere in the Gallery was starting to turn strangely heartwarming...

Anonymous (39.7): Oh, I'm a bit curious about this. What was the cause?

That single question set ablaze the academic passion of the ghosts from various specialties residing in the Gallery.

Korean Slave 1: See the previous post.

Anonymous (39.7): Interesting. Is it a dissection? At 37 weeks, blood volume peaks, so is it possible the aorta couldn't withstand the intravascular pressure and tore?

It wasn't impossible. It was an interesting deduction.

Thoracic Surgery Fossil: Doesn't look like a dissection, though?

But unfortunately, the anonymous user's claim was immediately refuted by a ghost who was a thoracic surgery specialist—one of the departments that sees the aorta the most.

‘Why did that ghost think it wasn't a dissection?’

Setting the ghosts aside, I started forming my own hypothesis. If it were a dissection, the patient should have complained of tearing back pain. Moreover, if a dissection caused a shock severe enough to trigger an arrest in such a short time, it would mean cardiac tamponade had occurred, in which case there's no way I could have stopped the bleeding with just packing.

Was that his reasoning? Putting it together that way made it seem quite rational.

Cardiology Ghost: Could it be AFE?

The Cardiology Ghost suspected a classic case of amniotic fluid embolism.

‘Since "Mes of the God" is shortened to "Mes-God," should I call this guy "Cardio-Ghost"? Hmm... sounds lame.’

Shaking myself out of those idle thoughts, I focused and began to properly analyze the disease. That claim hypothesized that amniotic fluid was sucked into the blood vessels, completely blocking the pulmonary artery, which caused right ventricular failure, leading the end-tidal carbon dioxide partial pressure to hit rock bottom.

Pathophysiologically and logically speaking, this was the most plausible explanation so far.

Latte is Mine: But honestly, isn't this the first time Hell Slave has pulled off something of this caliber with a solo procedure? Congrats.

Hippocrates' Descendant: O living doctor, with all my heart, I truly congratulate you!

And so, I quietly stared at the Gallery, which had turned into a hybrid of a deduction contest and a "praise the Hell Slave" festival for the first time in a while. Watching them engage in a keyboard battle—refuting each other's opinions and bringing up their own clinical experiences—made me feel...

What should I call it?

It felt like I had developed a deeper sense of belonging to this cursed community of ghosts.

Doctors handle people's lives. They treat, consult, and help together, but they don't carry every single emotional burden together. It was the security of knowing that the heavy burden of a life, which I had to shoulder all by myself, was now being shared with these genius doctors hiding behind anonymous usernames.

Ah, they always said you shouldn't seek a sense of belonging in an online community.

I chuckled to myself at the thought.

To be honest, back when I was a 1st-year resident, launching any question or comment into this Gallery would routinely be met with a barrage of profanity.

‘Are you trying to kill someone, you damn quack?’

‘Fck, even pig skin has human rights, you bastard!’

Back when I was a clueless 1st-year who panicked whenever vitals fluctuated, the ghosts' harsh teaching style was practically the default setting. Yet, looking back now, it felt like the criticism had strangely dwindled.

Without the help of other staff, and even without being possessed by a ghost, I had managed to successfully perform a PMCD on a full-term mother using strictly my own two hands. If so, hadn't I finally climbed to a position where I was properly recognized as a true emergency medicine physician, even by those fastidious old bastards?

Ding-

[A comment has been registered.]

‘Huh?’

Mes of the God: Hell Slave, you did well. But surely you don't think that just because you managed to split a belly open on time once, you've completely independent from our shadow, right?

Operating Room Ghost 3 (Male): We definitely need to break his spirit. Agreed, agreed. Lately, Hell Slave's shoulders have been so puffed up from a little praise that his eyes look completely arrogant.

Hippocrates' Descendant: O living young doctor, your training is not yet finished! Do not forget that pride is a doctor's greatest enemy!

‘...Damn ghosts.’

I promptly threw the sense of belonging and respect I had felt just seconds ago straight into the trash bin of my mind.

Two weeks flew by in a flash since the helicopter transport of the mother and the PMCD incident in the Resusc room.

Taking that day as a turning point, Ji Yeong-eun, a 4th-year OB-GYN resident, and I became well-acquainted enough to casually ask each other about patients' conditions. And today, at the hospital cafe, I heard some welcome news from her.

"She was discharged?"

"She was discharged. Right after morning rounds today."

"What's her condition? How is she? Is her neurological status completely normal? Any paralysis or cognitive decline? Did neurology definitely sign off on the consultation? When was she moved from the ICU to the general ward?"

Overwhelmed by my rapid-fire, lab-like questions, Ji Yeong-eun hurriedly raised her hands to stop me.

"Hey! One at a time, ask one at a time. I'm not a call center employee."

"Ah, sorry. I'm really sorry. It's just that I've been losing sleep because I was so curious. It was the first time I performed a PMCD with my own hands, so I kept worrying that maybe because of me..."

It was the guilt and pressure that any doctor would likely experience at least once.

What if my timing in cutting open the abdomen was ten seconds too late, leaving permanent brain damage? What if I didn't achieve perfect hemostasis, and something went wrong in the operating room?

These thoughts and anxieties had consumed my mind for the past two weeks. That was why this question mattered so much. How did my decision ultimately affect the mother?

"Please calm down, Hyunjae. To give you the conclusion first, she walked out on her own two feet perfectly fine, so stop worrying. Got it? Though she did trigger DIC (disseminated intravascular coagulation)..."

"...Right."

DIC. That's truly the worst-case scenario.

One of the reasons amniotic fluid embolism is called the most horrible disaster in the obstetric field is precisely because of this. The pulmonary artery gets blocked, causing cardiac arrest. Okay, that part makes sense. But does it end there? No.

While cardiac arrest can occur, the bigger issue is that materials from the amniotic fluid mix into the maternal bloodstream, completely paralyzing the entire systemic blood coagulation system. It endlessly generates microthrombi throughout the blood vessels while simultaneously exhausting all the clotting factors needed to stop bleeding in an instant.

When that happens, the bleeding doesn't stop. If blood pours out from every organ and surgical site in the body, what are the chances of survival?

"We managed to control it with transfusion therapy."

"You controlled that? The DIC?"

"If you check the labs, the D-dimer and coagulation profiles spiked but then stabilized. Seriously, I thought I was going to die of overwork from wiping up blood in the operating room that day."

"Wow... the ICU and the surgical team must have gone through absolute hell."

The surgical team would have suffered, and the critical care staff handling the post-operative care in the ICU must have gone through immense hardship as well.

"Tell me about it. Everyone's life expectancy probably dropped by a month."

"So, what was the final diagnosis? Why did she arrest?"

To be honest, I was dying to know this too. From an emergency medicine perspective, once a patient with a stopped heart is revived and safely transferred to the back-up department, there's no absolute need to uncover the exact underlying cause. However, I wanted to verify the correct answer to the topic the Gallery ghosts had spent all night keyboard-battling over.

"Acute right ventricular failure and pulmonary artery vasospasm caused by AFE (amniotic fluid embolism)."

"Ah."

The Cardiology Ghost nailed it.

"Anyway, after they controlled it in the OR, she went down to the ICU and immediately received TTM (targeted temperature management) at 33 degrees."

"Right."

Targeted temperature management, which drops the body temperature to 33 degrees Celsius, is also known as therapeutic hypothermia. Why do we do this? When cardiac arrest occurs, it inevitably brings about brain damage. To prevent that damage, TTM is used to slow down brain cell metabolism and reduce edema.

"Four days later, she was moved to the general ward, mentally alert with absolutely zero neurological deficits. And on the twelfth day, all her lab values returned to normal, so she was discharged. The baby still needs to grow a bit more in the NICU, so he's still at the hospital, though."

"Ah... thank goodness."

Phew. I let out a long sigh. "Really, thank goodness."

Because it was my very first case holding the scalpel completely alone, I had been worried out of my mind. Every night, I had questioned and doubted myself, wondering if I had hesitated for even a single second during that four-minute time attack from the moment the helicopter doors opened.

I had been burning up inside with anxiety, masking it with an exterior of composure, terrified that a tiny hesitation might have caused her brain to rot, leaving neurological sequelae, or that it might have cast a lifelong, irreversible shadow on the newborn baby.

But to hear that wasn't the case. To hear that my judgment was correct and had preserved the intact future of two people.

It was an immense relief.

"Good job. I should get going now."

Ji Yeong-eun patted my shoulder and walked out of the hospital cafe.

I quietly turned my head to the right, gazing through the glass window at the clear, blue sky.

‘Yeah. Now I, too, am a proper doctor who can save lives without relying on someone else's hands...’

Right at that perfect moment, just as a warmth swelled in my chest and self-confidence began to take root...

Ding-

[Comment]

Mes of the God: Hell Slave, it's time to train.

‘Fck.’