Chapter 120
The second phone rang.
Same ringtone.
But for some reason, this ring sounded far more ominous.
A phone ringing from the same number again within a short time in the ER.
That usually means one of two things.
A major disaster has happened.
Or the patient from earlier couldn’t find a place to go, kept circling around, and called us again.
My intuition reacted before the nurse even answered the phone.
A chill ran down my spine.
I’m screwed.
The nurse picked up the receiver.
“Cheongjindae Hospital ER… yes? Ah… just a moment.”
The nurse looked at me.
I could tell just by the shape of her mouth.
‘It’s the ambulance crew from earlier.’
So they’d been rejected everywhere.
And now the patient was on the brink of death.
The paramedic was probably calling back, forced to swallow their pride, begging us to take the patient in even though there was no operating room.
I squeezed my eyes shut and opened them again.
Here it comes.
“This is the ER doctor on duty. Go ahead.”
I tucked the receiver between my ear and shoulder and grabbed a notepad.
[Doctor, the patient’s BP has dropped into the 60s! He’s in a stupor right now!
(* stupor)
His abdominal distension is getting worse too!]
“...”
[Isn’t there any way you can take him?]
Two selves in my head collided wildly.
‘Fuck.’
If I accept him, I’m fucked.
There’s no surgeon to operate.
Both vascular surgery and thoracic surgery are completely full.
Even if we took him, we’d probably just keep pouring blood into a bottomless bucket and end up pronouncing him dead right in front of me.
On top of that, even if I tried using a skill or whatever, there’s no anesthesiology team.
I don’t have two bodies.
‘If I don’t take him, I’m fucked too.’
If I refuse now?
This patient will die inside the ambulance before finding the next hospital.
When a ruptured abdominal aortic aneurysm bursts, blood gushes out like a fountain.
BP in the 60s? He’s already at the edge of shock.
If we turn him away here...
‘Could we at least do treatment and initial stabilization...?’
Take him in first and pour in fluids.
Raise the blood pressure.
And if we could block the bleeding with something like REBOA... then what if an operating room opens up at another hospital?
Or if surgery at our hospital miraculously finishes early?
‘It’s a gamble. Just wishful thinking.’
I don’t know.
Even if there’s the slightest chance...
“Sir.”
I drew a breath.
“We’ll somehow do at least the treatment for that patient. I can’t promise surgery. If you bring him here, we’ll at least treat him in the ER. Bring him in.”
[Yes! Thank you! Three minutes! We’ll be there in three minutes!]
Hope crept into the paramedic’s voice.
Click.
The call ended.
I slammed the receiver down like I was throwing it and stormed out of the station.
Behind me, the PD was startled and smacked the cameraman.
“Doctor?! What happened?”
Sorry, Mr. PD.
I don’t have time to answer you right now.
I shouted so loudly the hallway rang.
“Set up the resuscitation area! Everyone, gather up! We’ve got an rAAA shock patient coming in!”
The atmosphere in the ER changed in an instant.
The interns idly looking at charts and the nurses organizing IV fluids sprang into action at my shout.
“Everyone gather up first! ETA is three minutes! Bring out every unit of type O blood we have. Call the blood bank right now and tell them to prepare the massive transfusion protocol!”
“Huh? MTP?”
The nurse asked back.
Massive transfusion, even before the patient had arrived.
“Yes! In a 1:1:1 ratio! Prepare packed red blood cells, plasma, and platelets! We need to start infusing the moment the patient arrives!”
As I ran to the resuscitation bay, I turned it over in my head.
BP in the 60s.
Get lines in, run fluids, pour in blood.
Start vasopressors.
But even then, it’d be like plugging a burst dam with your fingers.
Without definitive hemostasis, it’s just a bottomless bucket.
‘REBOA. We have to do REBOA.’
We have to insert a balloon into the aorta to block blood from flowing downward.
That way, at least the blood going to the brain and heart can be preserved.
But me?
A second-year resident?
Last time the Scalpel God possessed me and did it, but this time, while fully conscious?
“Hyeonjae, what is it?”
Just then, emergency medicine fellow Park Se-young appeared at the entrance to the resuscitation bay.
He must have heard me shouting and run over.
“Doctor!”
“What patient is it? rAAA?”
“Yes. A man in his sixties. He’s in shock from a ruptured abdominal aortic aneurysm. He’s been rejected by every other hospital and is being sent back to us. Blood pressure’s in the 60s.”
“Did you call surgery? The surgeons?”
“No. Professor Song from vascular surgery is in the middle of an rAAA operation right now, and thoracic surgery is doing a CABG. The ORs are all full.”
“What?”
Park Se-young was horrified.
“Hey! Why would you take an rAAA when there’s no operating room? Are you insane?”
“They said everyone else turned him away, so I’m trying to at least do some treatment. Even if another hospital in a different region accepts him, isn’t it better to at least get blood in him first before sending him?”
Park Se-young bit his lip.
“Still, just in case, I’m going to finish setting up and call right away. Surgery might end sooner than expected, and if all else fails, maybe the fellows can come down.”
“You lunatic. So how are you supposed to do it? There’s no doctor who can open the abdomen.”
“I don’t know. I need to stabilize his vitals and buy time first...”
I stood beside the resuscitation bed and put on my gloves.
“We’ll have to keep him alive by giving him blood.”
“Hah, a method? Let’s see. What would even work? Blood alone isn’t enough...”
Park Se-young was biting his nails, looking anxious too.
In that brief gap, I opened the gallery.
Help me, Gallerymon.
I just can’t be confident with my own skill alone.
If I fail, the aorta will tear, or the patient will die instantly.
‘Scalpel God, please save me.’
The PD was holding a camera up beside me, but the broadcast wasn’t important right now.
[Dead Medic Gallery]
=========================
@ScalpelGod
Author : HellJoseonSlave1
REBOA might really have to be done just one more time. rAAA patient. No OR. Need to buy time.
=========================
Not long after I hit the upload button, an alert sounded.
[Comments]
ScalpelGod : Yeah.
Just two characters.
That short reply was more reassuring than an army of tens of thousands.
He knows too.
What I’m trying to do, and how utterly fucked the situation is.
‘Good.’
In the distance, sirens began to sound.
I spotted first-year Park Seong-jeong standing blankly to the side.
“Park Seong-jeong!”
“Yes, sir!”
I fidgeted with the sterile gloves and shouted at Park Seong-jeong.
“Don’t come in here! Stay out and keep holding the station phone!”
“Huh? Then I...”
“Call every hospital you can find! Any hospital that can do rAAA surgery, any hospital with an operating room open right now—start dialing and find one fast! So we can send him there the moment his vitals are stable!”
“Ah... got it!”
Park Seong-jeong went pale and ran to the station.
Skreeeeech-!
I heard the sound of a sudden brake being slammed outside the ER’s automatic doors.
“Move! Patient coming in! Clear the way!”
The moment the automatic doors opened, the paramedics’ shouts filled the ER.
The patient’s face was already deathly pale, and you couldn’t even hear rough breathing from beneath the oxygen mask.
“Transferring! One, two, three!”
Thud!
The patient was moved onto the resuscitation bed.
It was such a precarious situation that even that jolt seemed like it might drop the patient’s blood pressure.
“Hook up the monitors! Cut off all his clothes!”
The treatment team rushed in and tore the patient’s clothes apart with scissors.
“BP is 50 over 30, and pulse is 130! We can’t get the saturation!”
50 over 30.
Could you even call that blood pressure?
“Get 16-gauge lines in both arms—no, 14-gauge if you can get them, use the thickest ones possible! If you can’t get them, go straight to IO
(* intraosseous)
drill it in!”
I urgently gave the orders.
“Yes! It’s ready!”
“Dr. Park Se-young! Sorry, but could I ask you to place the central line? I’ll get the femoral artery!”
Fellow Park Se-young beside me nodded.
“Uh, got it! Intern! You, come here and press on this!”
The ER turned into a battlefield in an instant.
Wrappers were torn open, and alarms kept blaring nonstop.
To do REBOA, I had to secure the femoral artery.
But the patient’s pulse was too weak.
‘...I can’t feel it.’
The pulse that should have been felt at my fingertips wasn’t there.
If the blood pressure drops too much, not only peripheral arteries but even the femoral artery disappears.
“Blood pressure is dropping further! BP is down to 40...”
Sweating like rain, I ordered norepi, a vasopressor, and draped the sterile sheet.
My hands trembled slightly.
I had to find a vessel I couldn’t see or feel, shove in a thick catheter, inflate the balloon, and block the aorta.
If I fail?
He dies on the spot.
“Ugh...”
The patient let out a pained groan.
His consciousness was fading.
A sign that even the blood flow to the brain was being cut off.
“Patient! Can you hear me? Open your eyes!”
The nurse shouted, but the patient’s eyes were glassy, staring into the void.
“Doctor! I think the patient’s about to arrest! The EKG is flattening!”
An intern shouted.
The ECG waveform was becoming flatter and flatter.
Okay, everything was ready.
So now...
‘Help me.’
‘Possess me, Scalpel God.’
At that moment.
Swoosh-
The noisy monitor beeps, the nurses’ shouts, and Park Se-young’s urgent orders all faded as if they were submerged underwater.
My sensations changed.
Ah, who knew this disgusting filth would feel so welcome.
‘...He’s here.’
The Scalpel God slowly raised his head and glanced at the monitor once.
“Hah.”
A dry laugh escaped my lips.
He pressed hard on the patient with a gloved finger.
Deeply.
Deeper.
But all his fingertips could feel was soft flesh and limp tissue.
The place where a vessel should have been was silent like an empty cavern.
There’s no pressure.
The vessel had shriveled so much it was stuck together like paper.
Should I go in blind?
No, no.
There’s no pulse, so where am I supposed to puncture?
Besides, this isn’t even an operating room.
I can’t open the abdomen.
I have to snag this dying person’s lifeline with nothing but this slender needle.
The Scalpel God lowered his head, as if speechless.
And then he soon muttered in a low voice.
“You hell slave...”
The Scalpel God pressed on the pulseless skin once more and muttered.
“How the fuck am I supposed to do this...”