Chapter 107
“Now, buckle up. Both shoulders through, then cinch it tight at the waist.”
Following Professor Kang’s gestures, I fastened the harness.
It was on a completely different level from a car seatbelt.
It felt like getting into a racing car.
“Oh, this harness is wild.”
While I was muttering, an enormous roar burst out overhead.
Wheeeeeeeeen—
Thud-thud-thud-thud-thud!
The tremendous noise hammered my eardrums.
The floating sensation of the aircraft lifting wrapped around my whole body.
Below my feet, the H mark on the hospital rooftop was growing distant.
‘…So this is the sound a helicopter makes, the one I’ve only ever heard on the news!’
Honestly it was a little nerve-racking, but it was amazing.
Me, riding in a helicopter.
In a doctor’s coat, no less.
“Here, put this headset on. With the noise, I can’t hear you if you just talk.”
“Ah, yes sir.”
I put the hefty headset Professor Kang handed me over my head.
The ear-splitting roar went muffled in an instant and voices came through clearly.
The nurse sitting facing backward in the seat in front of me was reading a sheet of paper, apparently used to the shaking cabin.
The name tag on her chest.
[Flight Nurse An Nayeon]
‘An… Nayeon. Okay. Let’s memorize the name.’
She’s a comrade I’ll be sharing life and death with in this cramped helicopter from now on.
Just then some unintelligible alien language came through the headset.
[~~]
“…What was that, Professor Kang?”
When I asked with my eyes wide, Professor Kang snorted a laugh.
“Ah, that’s the captain on the radio. You don’t need to pay it any mind. We just do our own job. Now let’s see….”
Professor Kang took his phone out of his pocket and opened his messages.
“You checked the patient’s symptoms and vitals?”
“Ah, yes. Chest pain started thirty minutes ago, blood pressure 100 over 60. Suspected inferior wall infarction with bradycardia.”
“Right. Look over the extra information that came to my phone. The public health doctor at the branch clinic sent an EKG photo too. You see the ST segment elevation?”
I burned the electrocardiogram on the shaking screen into my eyes.
No doubt about it.
It’s blocked.
“What’s the first treatment after we land?”
A sudden oral exam.
I turned my head over.
“First check the scene is safe, then approach the patient, secure the airway and get a line in…?”
“That’s right. And they already gave him aspirin, so that’s done. If the pain is bad, consider nitroglycerin or morphine. Above all, get the monitoring firmly attached before we load him into the helicopter. Once we’re up it’s too loud to use a stethoscope. You have to read the vitals with your eyes alone.”
And so the helicopter picked up speed heading south.
Outside the window the scenery was gradually turning from a forest of buildings to blue.
A question suddenly flared up in me.
“By the way, Professor Kang.”
“Yeah.”
“Aren’t you trauma surgery, sir? This is a cardiac emergency. Is it all right for you to be the one going?”
Isn’t an internal medicine emergency like this usually emergency medicine or cardiology territory?
A trauma surgery professor who cuts bellies open and sets bones, going out to see a myocardial infarction patient.
Professor Kang shrugged.
“That’s just how the doctor-helicopter team is put together, what can you do. There’s no manpower, and patients keep happening. If a cardiac patient comes in while I’m on call, I go.”
He grinned.
“And I know plenty of emergency medicine too.”
“Is that so?”
“Back in my day, in the early days of emergency medicine, surgeons like me spent a lot of time down in the ER, so we were half emergency physicians ourselves. I’ve been through it all. Intubation? Lines? I’d bet I’m better at them than you.”
Professor Kang’s eyes went distant, as if sinking into old memories.
Ah, I poked the wrong thing.
I hurriedly changed the subject.
“So, uh, let’s keep going with the patient briefing….”
“Ah, right. Ahem.”
Right on cue, An Nayeon started saying something over the intercom.
[Professor, I spoke with the branch clinic again. The patient’s cold sweats have gotten worse and he’s showing signs of vomiting. They said they can hear the helicopter, so the ambulance is moving to the rendezvous point.]
“Okay, understood. Six minutes to arrival!”
I looked out the window.
The dazzlingly glittering South Sea spread out beneath our feet.
A landscape dotted with islands.
One of them is our destination.
Whup-ta-ta-ta-ta-ta-ta-ta—
As the ground drew closer the rotor noise turned even sharper.
A wind of dust kicked up.
‘Ugh, so loud.’
The moment the helicopter touched down I threw off my headset, flung the door open and jumped out.
On the ground a fire department ambulance, a public health doctor in a white coat and the paramedics were already waiting for us.
The public health doctor’s face was the color of dirt.
You could see plainly how he’d been on edge, terrified the patient would die in his hands.
“You’re here!”
The public health doctor shouted, but the helicopter noise buried it into something small.
Professor Kang Hyunjun moved to the patient’s side with practiced ease and asked in a loud voice.
“Briefing, please!”
“Yes! Fifty-nine-year-old male, one hour since onset of chest pain! Initial EKG confirmed ST elevation in II, III and aVF, and I couldn’t give nitroglycerin because his blood pressure is 90! He’s only chewed 300mg of aspirin!”
“The pain?”
“He’s still complaining of it! And the cold sweats haven’t stopped!”
I put my stethoscope to the patient’s chest.
Professor Kang made the call.
“Okay! No time to waste. Load him now! We’ll connect the monitoring in the cabin!”
“Then we’ll be off! Thank you for your work!”
We lifted the stretcher the patient was lying on.
The public health doctor and the paramedics let out sighs of relief and saw us off.
“Yes! Please take care of him!”
Clack!
The sound of the stretcher locking into the fixture inside the helicopter rang out dully.
Professor Kang, An Nayeon and I folded ourselves into the cramped cabin.
“Let’s take off!”
The helicopter rose into the air again.
In that tight space we bumped elbows as we connected line after line to the patient’s body.
“Monitor’s up! BP 90 over 60, HR 55. SpO2 94%….”
An Nayeon called out.
“Get another line in. Just in case, open the fluids all the way. Give 2mg of morphine for pain control.”
I took the patient’s arm with practiced hands and searched for a vein.
An IV inside a shaking helicopter was ten times harder than one on solid ground.
But it seems my two years on the job weren’t for nothing.
Got it on the first try.
Maybe I’m finally crawling out of butterfingers territory.
“Line secured.”
“Good. Just keep it up like this. Sir, it’s about twenty minutes to Busan, so let’s hang in there.”
Professor Kang patted the patient’s shoulder.
The patient nodded even as cold sweat poured off him like rain.
That was when it happened.
“Ugh…!”
The patient’s body suddenly went stiff as a plank.
His eyes rolled up white.
“Huh? Sir!”
Before I could even shout, the monitor screamed.
Beeeeeeeep—
The regular EKG waveform twisted in an instant into a filthy tangle of thread.
His heart had stopped.
“V-fib
(* ventricular fibrillation)
!”
Professor Kang shouted reflexively.
“We have to shock him! The pads are on, right?”
The cramped helicopter cabin turned into chaos in an instant.
I half rose to my feet.
My head almost brushed the ceiling.
“200 joules! Charge!”
“Everyone clear! Shock!”
Thump!
The patient’s upper body jerked up.
We held our breath and watched the monitor.
The squiggling waveform paused for a moment, then started beating again.
“Rhythm’s back….”
“It’s back… phew….”
I let out a sigh of relief and reached out to check his pulse.
But before my hand even reached the patient’s neck.
Beeeep—
“It’s up again! V-fib again!”
The waveform on the monitor was dancing madly once more.
Arrest again.
“Start compressions now! Give 1mg of epi!”
Professor Kang squeezed through the narrow space and put his weight over the patient’s chest.
Push, push, push, push.
“Epi is in!”
“Two minutes! Check the rhythm!”
Professor Kang lifted his hands.
The waveform returned to normal again.
“Did we get it?”
But that relief didn’t last ten seconds.
Beeeeeep—
“Oh, this is maddening! Again!”
The third V-fib.
“Mix 300mg of amiodarone and hang it! Get the shock ready again! Charge!”
“Shock!”
Thump!
The patient’s body jerked up.
But this time it didn’t come back.
The waveform on the monitor was still dancing, drawing its filthy sawtooth.
“Compressions again!”
I started compressing the patient’s chest.
The helicopter’s vibration tangled with the rhythm of my compressions until my back felt like it would snap.
“Get lidocaine ready too! Keep giving epinephrine every three minutes! The moment the shock is ready, hit him!”
We moved like people gone mad.
Me, the nurse, Professor Kang, all of us moving mechanically by the ACLS
(* Advanced Cardiovascular Life Support)
protocol.
The drugs went in, the electricity jumped, his breastbone was pressed hard enough to crush it.
But the patient’s heart, as if mocking us, would come back for a moment and then collapse right back into that horrible waveform.
A fourth shock.
The patient was dying.
‘Why won’t it hold?’
I could feel the patient’s ribs crackling under my palms.
Cold sweat ran into my eyes and stung.
That was when something flashed deep in the back of my mind.
A very long time ago. No, only a few months ago.
Something the Cardiology Ghost had rambled about.
‘…Huh?’
Hold on… this is… a ventricular arrhythmia occurring three or more times within twenty-four hours.
‘Electrical Storm
(* an electrical storm of the heart)
.’
My eyes flew open.
Without stopping the compressions I raised my head and shouted.
“Professor! This is an Electrical Storm! Drugs won’t stop it!”
Professor Kang looked at me with a sweat-soaked face.
“So what do you want me to do! It isn’t stopping, which is exactly why we keep shocking him and pushing drugs!”
“We have to block it! We have to cut the sympathetic nerve to make it stop!”
“What?”
I spat out the term I’d seen on the Gallery.
“We have to do an SGB
(* stellate ganglion block)
! We have to shoot anesthetic into the left side of his neck and cut the sympathetic nerve, or this patient dies!”
Professor Kang’s eyes went wide.
The helicopter rattled slightly in a gust of wind.
“You want to stick a needle in his neck in this shaking helicopter? And if you hit the carotid!”
Precisely spearing a ganglion deep in the neck with a needle, in this cramped, shaking space?
It’s insane.
If it fails, the patient dies.
But the monitor was still V-fib.
At this rate his brain will melt before we even reach the hospital.
There’s no choice.
“I’m not going to kill this patient.”
“What?”
With my own hands it’s impossible.
But if it’s him.
If it’s that madman who knows every road in the heart.
I hurriedly scrawled a memo for the ghost who was about to be met with a sudden possession.
‘Possession. Cardiology Ghost.’
The world turned over once again.