Chapter 263

Episode 263. NS Conquest (3)

Clap!

Park Seungwoo clapped his hands to draw attention. Frankly, there was no real need to clap anyway. After all, there were only three people here.

“Yes, it was a case where differential diagnosis was considerably difficult even with DSA (Digital Subtraction Angiography) and general 3D-CTA.”

Park Seungwoo turned his head and asked me, “When differentiating such rare anatomical variations, what do you think is clinically important?”

‘Don't know.’

I really didn't know. Should we all log into the community of dead ghosts who are fluent in medicine and gather information? But that wasn't the answer. I turned my head and opened the gallery window.

Flash—

[Dead Medic Gallery]

What is the important differential point when differentiating?

Author: Korean Slave 1 (Male)

It feels more like 3D-CTA rather than DSA?

[Comments]

Mes of the God (Male): What differential diagnosis at all?

Ah, shoot. I omitted the subject. I hurriedly left a reply to add information.

Korean Slave 1 (Male): The case that Head Craniotomy reviewed this morning.

Latte is Mine: Um, don't know.

Hippocrates' Descendant: For things like this, it is most accurate to hear from the person who provided the advice, O living doctor!

Head Craniotomy: Look, historically, the majority of infra-optic A1 segments were unexpectedly discovered during surgery.

Korean Slave 1 (Male): I know that.

At my criticism, Head Craniotomy seemed a bit embarrassed.

Head Craniotomy: Really…?

Korean Slave 1 (Male): Yeah.

Mes of the God (Male): Shouldn't Craniotomy look back at his own head?

Head Craniotomy: Shut up.

“…Um, Teacher Han?” Park Seungwoo called me.

Ah, damn it. Time flew by while watching these guys banter.

“Ah, if you could please give me just a moment, I will think about it a little more.”

Park Seungwoo seemed to like my attitude. Even now, the way he nodded with a smile made me feel to the point of thinking, 'Yes. If it's you, you'll find a way.'

'Come to think of it, was it on the way to the Operating Room? Seeing how he cursed at the residents of his own department….'

It was true that he complimented me, but it was also true that he bashed the residents of his own department. No matter how much I thought about it, the answer wasn't something that would just pop up with a little bit of thinking.

I turned my head again and stared blankly at the window in the void.

Korean Slave 1 (Male): Tell me the method quickly. What is the point?

JustWatchingImagesFromMyRoom: Two-dimensional digital subtraction angiography often fails to accurately depict the spatial relationships between abnormal vessels, optic nerve structures, and adjacent skeletal structures.

Korean Slave 1 (Male): And?

JustWatchingImagesFromMyRoom: Usually in NS, they mostly look at DSA before entering to see the brain. So it's hard to discover it right away.

Head Craniotomy: Yeah, correct. So on standard angiography, this anomaly is frequently misdiagnosed as just a low bifurcation of the internal carotid artery, or an atypically elongated A1 segment.

'If that's the case….'

Now I finally got a clue. I had an idea of where to focus.

“I think the important differential point in this case might be the story about the value of preoperative 3D-CTA.”

“The value of 3D-CTA, you say?” Park Seungwoo stroked his jaw with an interested look.

“Didn't I meticulously analyze the raw data of the rotational images and reconstruct the images using multiplanar bone window settings?”

“That's right.”

Glance—

I briefly cheated by looking at the window in the void.

'Input complete.'

To emphasize the indispensable nature of using 3D-CTA, I decided to copy the criticisms against other existing methods word for word.

“I understand that two-dimensional digital subtraction angiography often fails to accurately depict the spatial relationships between abnormal vessels, optic nerve structures, and adjacent skeletal structures.”

At those words, Park Seungwoo let out a chuckle and smiled. “…Well, that makes sense.” Park Seungwoo nodded, expressing his agreement. “It is thanks to the 3D-CTA and the raw bone data that we were able to clearly check the path of the infra-optic course before the craniotomy.”

“…Yes, then gradually…”

I looked at Professor Park Seungwoo, who was about to stand up. What is it? Is he telling me to stand up too?

'Where is the etiquette in standing up suddenly while asking questions, Professor?'

As I tried to stand up that way, Park Seungwoo waved his hand to stop me.

“It's fine. Don't follow me. I'll be away from my seat for a bit due to work….”

Cough, cough!

Park Seungwoo cleared his throat and turned his head toward Hwang Sunghoon. Only then did Hwang Sunghoon go 'ah' and approached me while carrying a laptop.

“Ah, yes! I will help write the draft.”

At those words, Park Seungwoo nodded with a look of satisfaction.

Thud—

Park Seungwoo left the conference room, and Hwang Sunghoon wiped his sweat as he spoke. “Teacher Han Hyeonjae. Oh, so, you'll be writing a neurosurgery paper….”

“It's fine.”

“Pardon?”

“Even so, while doing neurosurgery, I studied a lot about this case… so I think it would be fine if you just work hard on preparing your own paper.”

I indirectly expressed my thought that I didn't particularly need his help as much as possible. Then Hwang Sunghoon nodded.

“Thank you for being considerate.”

“Ah, no! It's only natural to help. After all, the patient was able to undergo surgery properly thanks to you, Teacher. And in the first place, since you are a dispatched resident, it's originally right for me to help you…”

I flashed a bright smile.

'Just as Eunseo pointed out… so I don't look like a psychopath.'

Hmm. I must have smiled naturally. I tried my best to ignore how Hwang Sunghoon’s expression flinched with bewilderment in a strange way. I probably smiled well, whatever.

I started writing the draft just like that.

Clack—

Clack, clack, clack—

Seeing me writing down sentences with great effort, Hwang Sunghoon formed a strange expression and began to focus on his own data collection again.

Glance—

After confirming that Hwang Sunghoon's gaze had completely fallen off me, I opened the window in the void just like that.

Flash—

Korean Slave 1 (Male): I have to write a paper.

Cardiology Ghost: ??????? Suddenly?

Korean Slave 1 (Male): An NS professor wants me to write one. With the case that Head Craniotomy lectured on.

Head Craniotomy: So what do you want me to help with?

Korean Slave 1 (Male): This isn't an emergency medicine paper.

That's right. By all accounts. The part where I needed help was...

Korean Slave 1 (Male): Everything.

Help me.

'Ghosts, it's your field of expertise.'

Like that, I started writing the paper.

Korean Slave 1 (Male): Contemplating how to describe 'if we go with the original plan, we'll be screwed?'.

Head Craniotomy: Write it around this level: "If the frontal lobe and optic nerve are forcibly retracted using the conventional standard pterional approach without recognizing this variation, the A1 segment trapped beneath the optic nerve will compress the optic nerve, causing permanent ischemic optic neuropathy, or the aneurysm will tear due to the retraction force, resulting in intraoperative rupture."

Head Craniotomy: Write it to this extent.

Korean Slave 1 (Male): Can't you write it in English too?

Head Craniotomy: 🖕

Because of that, I had to write while looking up words in English one by one.

Head Craniotomy: Looking at this, what's fascinating is that the operating surgeon didn't physically pull the frontal lobe at all, right???

Korean Slave 1 (Male): Yeah, why is that?

Head Craniotomy: Why else? There's an anatomical variation, so what would happen if you lifted the frontal lobe?

'Aha.'

Then what kind of method was used in this surgery?

Head Craniotomy: Instead, it feels like they opened the Liliequist membrane and basal cisterns early to drain the trapped cerebrospinal fluid and hematoma as much as possible. They induced the brain to contract on its own so that the visual field would open up naturally.

Korean Slave 1 (Male): What is the significance of securing the left side first?

Head Craniotomy: Touching the right A1, which has the variation, is a suicidal act.

Head Craniotomy: Common sense, how do you place a clip there? Find and dissect the contralateral A1, which runs normally above the optic nerve, first, apply a temporary clip to preemptively control half of the bleeding risk, and then trace backward from the center of the brain down to the end of the right A1. You guys must have done it this way too.

I changed those stories into medical terminology for the paper and transferred them exactly as they were.

Clack—

Clack, clack—

“You write… really fast.” Hwang Sunghoon said while looking at me.

I showed an awkward smile. “Ah, just, you know… haha….”

Whether Hwang Sunghoon understood my awkward excuse differently, he quietly nodded his head and showed an unidentifiable smile.

Microsurgical Clipping of a Ruptured Anterior Communicating Artery Aneurysm Associated with an Infra-Optic Course of the A1 Segment: A Case Report

Hyunjae Han, M.D.,¹ Sunghoon Hwang, M.D.,² and Seungwoo Park, M.D., Ph.D.²*

¹ Department of Emergency Medicine, Cheongjin University Hospital, Busan, Republic of Korea

² Department of Neurosurgery, Cheongjin University Hospital, Busan, Republic of Korea

Thump—

I set down the completed first draft of the paper in front of Professor Park Seungwoo. Next to me stood Hwang Sunghoon, standing restlessly with a look that seemed to say, 'Even so, maybe I should have confirmed it….'

By all means, Hwang Sunghoon must have been anxious too. Entrusting a paper entirely to a resident from another department is indeed not an easy thing to do.

“Right, well, even if there are many parts to revise, don't be disappointed. In the first place, writing a paper for another department well is close to impossible……”

Park Seungwoo said so and began to turn the pages.

“….”

Rustle—

Rustle—

Flip, flip—

Scribble—

Scribble, scribble—

While reading the draft of the paper, Park Seungwoo marked something with a pencil or fell deep into thought. And right after closing the last page.

“…Teacher Han.”

“Yes, Professor.”

“Do you by any chance have a neurosurgery specialist license?” Park Seungwoo clicked his tongue and quietly aligned the papers neatly. “Well, there is nothing to revise.”

Just like that, I became the first author of a neurosurgery paper.

Like that, it was the point where the neurosurgery dispatch was entering its 4th day. The cerebral aneurysm patient with the anatomical variation had also entered a recovery phase, and news was heard that they had recovered to the point where we could safely and slowly contemplate the schedule for transferring to a general ward.

And my nickname among the neurosurgery residents was….

“Thank you! Paper Manufacturer Teacher!”

I became a Paper Manufacturer.

“…Who on earth made up that kind of nickname….”

After I happened to help a few busy-looking neurosurgery residents by borrowing the power of the ghosts, a strange nickname was created.

“Teacher Yoon Heesu did… Ah, sorry!”

Whew—

As the neurosurgery residents left the doctor's office to do their own work, I quietly let out a sigh. And then, I turned on the window in the void.

Flash—

Head Craniotomy: Are the residents these days living with brains made of fucking udon noodles??????????

Head Craniotomy: No, seriously, write a sentence of this level yourself!!!!!!!!!!!!

'Sorry.'

However, because my true skills must not be exposed, the ghosts still have an obligation to help me.

It was the moment I was sitting blankly like that.

Buzz, buzz—

[Son Jong Son Joong Son Jangwoon]

It was a phone call from Son Jongwoon, a pediatric neurology fellow and my friend. Why is he calling out of nowhere at this hour?

“Hello?”

There was almost no reason for him to call me. Why would a pediatric neurology fellow call a 4th-year emergency medicine resident?

– Hey… are you by any chance rotating through NS right now?

Asking if I'm rotating through NS. It was a question that would usually be asked to an intern, but the situation is a bit different right now. Because right now, I am out here in the position of a dispatched emergency medicine resident. But how did he know about this unusual dispatch?

“Yeah. Dispatch to another department.”

– Hey, check your messages.

Click—

“…What is up with this bastard.”

I flipped off the void at Son Jongwoon’s trashy attitude of suddenly calling, bluntly saying only what he wanted to say, and hanging up, before logging into the messenger. What on earth…

'A news link?'

What appeared upon entering the chat was a copy-pasted news link. I thought nothing of it and clicked the link.

Tap—

[Exclusive] An Emergency Medicine Resident as the First Author of a Neurosurgery Surgical Paper?… Controversy Over Special Training Privileges to 'Build Up a Star' at A University Hospital in the Yeongnam Region

“…Eh?”