Chapter 272

Episode 272. Drowning (3)

"Sigh… then, the 1st Year. At least call them."

At my words, Baek Eunseo picked up the call phone again.

"Teacher, if we want to set up ECMO…."

Bzzzzz—

Right then, Lee Minjae hurriedly rushed into the Resusc.

"What's going on? Why is the patient like this? You said they were fine earlier."

It seemed he had run straight to the Resusc after managing a sudden arrest in Area B.

I checked the patient's vitals, replying without even turning my head, "Re-warming shock has set in. I gave norpine, but the BP isn't coming up."

"What about the vent settings? Oxygen saturation is in the 70s, shouldn't you raise the PEEP?"

"I already set it to 15."

Despite already aggressively increasing the positive end-expiratory pressure on the ventilator, the oxygen saturation kept dropping.

‘It's probably because of the drowning….’

When alveoli are filled with water and protein foam due to drowning, the lung's physical function of gas exchange itself can be completely lost. In this case, even if a ventilator is used…

‘The lungs won't be able to do their job.’

The lungs failing to function was bad enough, but there was another, even more serious issue right now.

‘The patient is hemodynamically collapsing.’

Currently, the patient's blood pressure was 75/40. Despite administering norepinephrine—a vasopressor—the blood pressure was falling instead of rising. It was a combination of rapid vasodilation from re-warming and myocardial damage caused by early hypoxia.

"An arrest is going to happen again at this rate," Lee Minjae said, his eyes filled with anxiety.

The pulse was 45. Now, even the measure of squeezing the heart with medication had reached its absolute limit.

The lungs couldn't function. The heart couldn't function either. Which meant, in short:

"We need to put them on ECMO."

Lee Minjae reached the same conclusion as I did.

"Did you call Thoracic Surgery? Shouldn't we put them on ECMO?"

At that question, while keeping my eyes fixed on the vitals monitor, I started to answer about our bleak reality.

"The Thoracic Surgery ECMO team is…."

"What about the ECMO team?"

"They say they are already tied up in the ICU."

"…Ah."

Lee Minjae furrowed his brow.

A hypothermic drowning patient. If we could just slowly raise their body temperature and buy a few days for the water in their lungs to be absorbed, there was a high probability they would walk out of the hospital normally again. That was why an ECMO, which could buy that brief window of time, was so desperately needed…

"Then what about the other Thoracic Surgery medical staff?"

"They say there's only one 1st Year on duty today."

"A 1st Year…."

A 1st Year in Thoracic Surgery. And a 1st Year before summer had even arrived, at that. At this point, a 2nd Year resident—rather than being an independent doctor—was usually someone who had just shed their intern skin and was barely adapting to their department.

Even so…

"Let's call them anyway."

I nodded at Lee Minjae's words. "Yes, Professor. That's why I had Eunseo call the 1st Year at least."

Just then, Baek Eunseo, who had finished her call, shoved the phone into her pocket and approached me.

"Uh, Han-ssam. And Professor. I did make the call, but…"

"Yeah."

At my reply, she hesitated before finally speaking, "They said bringing the ECMO down is a bit difficult."

"What?"

"What?"

The same word burst from Lee Minjae's mouth and mine at the same time.

Bringing down the ECMO is a bit difficult?

‘What kind of crazy bullshit is this?’

"They said it might be too much for a 1st Year to manage the ECMO alone… and asked if you could wait until the team arrives."

At those words, Lee Minjae exploded in frustration. "What crazy nonsense is that? Can't they see the patient's blood pressure? If we don't put them on ECMO right now, what do they think will happen…?"

I quietly opened the window in the void.

[Dead Medic Gallery]

I think the drowning patient is about to have a second arrest. Need to put them on ECMO.

Author: Korean Slave 1 (Male)

Re-warming shock set in, BP 75/40, spO2 in the 70s.

Looks like we need VA ECMO, but the ECMO team is tied up in the ICU and there's only a CS 1st Year.

[Comments]

ㅇㅇ (118.235): A 1st Year?

Korean Slave 1 (Male): yyyyyyyyyyy

Mes of the God (Male): Hm;

Korean Slave 1 (Male): You're CS GS Double Board, nim. Can you put them on ECMO?

‘Even so, that's a relief.’

The God of Mes, who held a double board in General Surgery and Thoracic Surgery, along with a subspecialty in Trauma Surgery. If it was Megod, he would surely know how to put them on ECMO in this situation…

Mes of the God (Male): It's going to be a bit tight.

Mes of the God (Male): We don't really use ECMO in trauma….

‘…Uh oh.’

Come to think of it, I forgot. To run an ECMO, you have to use a ton of heparin to keep the blood from clotting, but for trauma patients, stopping the bleeding is the top priority, so using heparin could cause them to bleed to death instantly. Since the Mes of the God (Male) had spent the mid-to-late part of his career dedicated almost exclusively to trauma patients, it made sense that he would be relatively less confident with ECMO.

Thoracic Surgery Ghost: I know how to do it.

Thoracic Surgery Ghost: I'm General Thoracic Surgery (pulmonary/esophageal).

‘Ah!’

Come to think of it, I had forgotten about the Thoracic Surgery Ghost. During last year's possession at the Geoje branch, this ghost hadn't stepped forward because he was a General Thoracic Surgery doctor (dealing with non-cardiac diseases). But it seemed he was finally going to step up.

‘Because General Thoracic Surgery handles the lungs.’

Inserting ECMO into patients with severe respiratory failure, where the lungs are completely ruined and even a ventilator doesn't work, is one of the core duties of General Thoracic Surgery professors. It's a subspecialty that uses ECMO like daily bread, even during lung transplant surgeries.

Korean Slave 1 (Male): Ok ok, I'll try to make a window for possession somehow.

Latte is Mine: The surgery bastards are getting possessed again.

Cardiology Ghost: If you're salty, go to a procedural department lol.

I closed the window on the ghosts' banter.

‘Good.’

For now, I had confirmed that a ghost could possess me and that we could insert the ECMO.

‘Now, let's do my job.’

My specialty. The primary trait of being the crazy bastard of the Emergency Medicine department.

‘Meddling.’

I reached out my hand toward Baek Eunseo. "Give me the call phone for a second."

"Pardon?"

When Baek Eunseo asked back in confusion, I extended my hand once more. "Can you give me the call phone?"

At those words, Lee Minjae also wore an expression that showed he guessed what I was trying to do.

"Hey, Hyeonjae."

"Yes, Professor."

"Are you about to…."

I cut Lee Minjae off. "Yes, I'm going to do what you're thinking, Professor."

"Haa… Right, well, it's true we need to put them on ECMO anyway…."

Lee Minjae ruffled his hair roughly, looking extremely frustrated himself.

"Right, even if the team comes later, the ECMO machine needs to be down here first for us to do anything."

As Lee Minjae nodded and expressed his agreement, Baek Eunseo reluctantly handed me the call phone.

"Thanks."

Beep—

Beep-beep-beep—

I dialed the extension number, pressed the call button, and the ringback tone started.

Ringgggg—

Ringgggg—

[Yes, this is Lee Sumin, 1st Year in Thoracic Surgery.]

A voice dripping with exhaustion… but I had no leeway to be considerate.

"This is Han Hyeonjae, 4th Year in Emergency Medicine. Can you push the ECMO machine down here?"

[Did you say ECMO?]

I could hear the voice over the phone coloring with panic.

[Uh… like I said earlier, the ECMO team is in the ICU right now…]

I held my forehead. "I know, I know… but at least drag the machine down here yourself."

[I haven't reported to the Professor yet… and for me to bring out equipment worth tens of millions of won without an order…]

"What?"

It wasn't even a valid reason for refusal—what do you mean the professor's confirmation hasn't come through? In the end, I decided to use one of the major evils of Korean society. Utilizing connections.

‘Let's see, a contact I can use….’

[Hello? Are you there?]

I pinned the call phone between my shoulder and ear while scrolling down my phone's contact list.

[ CS Professor Han Ihyun ]

‘Found him.’

A Thoracic Surgery professor who wasn't in the operating room when I checked the surgery status board earlier, and who would answer my call.

"Hey, 1st Year friend."

[Yes, Teacher.]

"Drag the ECMO down."

[What? But as I told you earlier…]

"I'll handle the Professor's confirmation myself, so hurry up."

The sheer panic in his voice was palpable even from here.

[Han Hyeonjae-seonsaengnim, that's…]

"The BP is constantly dropping right now, are you going to take responsibility if the patient dies because of you?"

[Uh….]

"I told you I'll get the confirmation."

[Yes, understood…]

Click—

"Hyeonjae, what are you going to do?" Lee Minjae walked over and asked.

"Well, it looks like I'll have to…."

Lee Minjae looked at me with his brow heavily furrowed. "Do you know how to insert an ECMO?"

"…Uh, well."

How should I explain this? Ah, whatever. It's true that I can do it once I use the possession ability anyway….

"Yes, I know how to insert an ECMO."

"Did you take the ECPR training?"

It was a question asking whether I had received training on ECMO insertion during cardiopulmonary resuscitation. If I had completed that training properly, inserting an ECMO wouldn't be out of the question, so it was a question thrown out to double-check.

"…Yes."

I decided to tell a benevolent lie. Donning the mask of a fake genius once again. To save a person. I had simply made that decision.

Rumble-rumble—

The heavy ECMO machine was rolled into the Resusc on its wheels.

"Gasp, uh… Thoracic Surgery. I'm Lee Sumin! That, you called…?"

Noticing that there were only Emergency Medicine staff present, Lee Sumin asked in a fluster, "Uh, you said you were getting the Professor's confirmation… which Professor will be doing the procedure…?"

At those words, I replied as I snapped on my gloves.

"The ECMO."

Snap.

"I will insert it."